Provider Demographics
NPI:1902340417
Name:HARRIS, KATIE E (CNM, WHNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:E
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:E
Other - Last Name:EPTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, WHNP
Mailing Address - Street 1:3104 ACTON ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2709
Mailing Address - Country:US
Mailing Address - Phone:202-658-8610
Mailing Address - Fax:
Practice Address - Street 1:3104 ACTON ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-2709
Practice Address - Country:US
Practice Address - Phone:202-658-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMW235828176B00000X
CANP95005533363LW0102X
CA235828367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health