Individual
TAMANTHA HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
69 HOLMES STREET, LAKE, MS 39092
(601) 697-0194
Mailing address
PO BOX 333, LAKE, MS 39092-0333
(601) 697-0194
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
909679
MS
163WH0200X
Home Health Registered Nurse
909679
MS
Other
Enumeration date
12/12/2023
Last updated
12/15/2023
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