Provider Demographics
NPI:1548448954
Name:HARRIS, TERESA LYNN (CRNP)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:LYNN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 VILLAGE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6477
Mailing Address - Country:US
Mailing Address - Phone:205-980-1744
Mailing Address - Fax:205-980-1334
Practice Address - Street 1:111 VILLAGE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6477
Practice Address - Country:US
Practice Address - Phone:205-980-1744
Practice Address - Fax:205-980-1334
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-082309363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner