1942032065 NPI number — NICHOLAS MARTIN HARRISON

Table of content: SIERRA CAITLIN DAYTON M.ED., RESIDENT (NPI 1568113504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942032065 NPI number — NICHOLAS MARTIN HARRISON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRISON
Provider First Name:
NICHOLAS
Provider Middle Name:
MARTIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1942032065
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5220 SPRING VALLEY ROAD, SUITE 400
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-466-1340
Provider Business Mailing Address Fax Number:
214-466-1378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4444 CORONA DR STE 144
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78411-4322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-854-1110
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2024

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: 224Z00000X , with the licence number:  218467 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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