MEDICARE: REBECCA H. HARRIS AGNP-C

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	363L00000X	Nurse Practitioner	5008203	NC

General Provider Information

NPI Number	:	1952774143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA H. HARRIS AGNP-C

Provider Business Mailing Address
First Line	:	PO BOX 68
Second Line	:
City	:	POLLOCKSVILLE
State	:	NC
Zip	:	28573-0068
Country	:	US
Telephone Number	:	252-635-3906
Fax Number	:	252-224-0378

Provider Business Practice Location Address
First Line	:	4252 ARENDELL ST STE E
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-0015
Country	:	US
Telephone Number	:	252-808-0145
Fax Number	:	252-808-2770

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

Provider Enumeration Date	:	11/10/2015
Last Update Date	:	10/04/2018

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