Basic Information
| Provider Information | |||||||||
| NPI: | 1235521881 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | MEREDITH | ||||||||
| MiddleName: | LEA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MSN, FNP-C | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | LEA | ||||||||
| OtherFirstName: | MEREDITH | ||||||||
| OtherMiddleName: | HESTER | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 585 QUAIL HOLLOW DR | ||||||||
| Address2: | |||||||||
| City: | ROXBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275748460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365042869 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 439 US HIGHWAY 158 W | ||||||||
| Address2: | |||||||||
| City: | YANCEYVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273798304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366941181 | ||||||||
| FaxNumber: | 3366941025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2015 | ||||||||
| LastUpdateDate: | 02/19/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 243108 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.