Basic Information
| Provider Information | |||||||||
| NPI: | 1881135135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | NATHANIEL | ||||||||
| MiddleName: | ANDREW | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2830 VICTORY PARKWAY | ||||||||
| Address2: | PAYOR ENROLLMENT | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452061785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135855507 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7798 DISCOVERY DR STE A | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450697747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134758264 | ||||||||
| FaxNumber: | 5134758265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2017 | ||||||||
| LastUpdateDate: | 10/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 53611 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 35.139789 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 53611 | 01 | KY | KY LICENSE | OTHER |