Provider Demographics
NPI:1003463134
Name:HARRISON, NICOLE (PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:HARRISON
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 BABBLING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-5369
Mailing Address - Country:US
Mailing Address - Phone:919-841-2465
Mailing Address - Fax:
Practice Address - Street 1:1708 TRAWICK RD STE 115
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3897
Practice Address - Country:US
Practice Address - Phone:919-841-2465
Practice Address - Fax:919-747-9462
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC230461163W00000X, 163WC1600X
291U00000X
NC5021305363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No291U00000XLaboratoriesClinical Medical Laboratory