Individual
DEREK R. HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN, APRN, CPNP-PC
Contact information
Practice address
1919 FAIRFIELD AVE, SHREVEPORT, LA 71101-4436
(318) 828-2210
(318) 828-2215
Mailing address
1919 FAIRFIELD AVE, SHREVEPORT, LA 71101-4436
(318) 828-2210
(318) 828-2215
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
AP07181
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2330578
—
LA
Enumeration date
02/08/2012
Last updated
06/17/2019
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