Basic Information
| Provider Information | |||||||||
| NPI: | 1235349812 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | MEGHAN | ||||||||
| MiddleName: | K. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1455 E BERT KOUNS LOOP | ||||||||
| Address2: | SUITE # 109 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711055634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187984458 | ||||||||
| FaxNumber: | 3187984474 | ||||||||
| Practice Location | |||||||||
| Address1: | 1811 E BERT KOUN LOOP STE 120 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711055741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182122720 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 201151 | LA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | P00885639 | 01 | LA | RAIL ROAD MEDICARE | OTHER | 1216577 | 05 | LA | MEDICAID | 21657 | 05 | LA | MEDICAID |