MEDICARE: DEIRDRENEY ANDRIA HARRIS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	97710	OK
2	363L00000X	Nurse Practitioner	219768	AZ
3	363L00000X	Nurse Practitioner	95012530	CA

General Provider Information

NPI Number	:	1659849420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIRDRENEY ANDRIA HARRIS NP

Provider Business Mailing Address
First Line	:	1817 ARLINGTON ST
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2814
Country	:	US
Telephone Number	:	580-279-0985
Fax Number	:	858-461-6008

Provider Business Practice Location Address
First Line	:	1817 ARLINGTON ST
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2814
Country	:	US
Telephone Number	:	580-279-0985
Fax Number	:	858-461-6008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2018
Last Update Date	:	06/08/2023

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