1235289026 NPI number — BRIANA LYNN HARRIS R

Table of content: BRIANA LYNN HARRIS R (NPI 1235289026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235289026 NPI number — BRIANA LYNN HARRIS R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
BRIANA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235289026
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
412 E BUSBEE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMDEN
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71701-7303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-574-2158
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11300 FINANCIAL CENTRE PKWY
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72211-3746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-221-2502
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 247100000X , with the licence number:  RTL6787 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2471C3402X , with the licence number: 399778 ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)