Provider Demographics
NPI:1588911705
Name:HARRIS, KET (DNP, FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KET
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DNP, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:KET
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP, PMHNP-BC
Mailing Address - Street 1:750 E US HIGHWAY 80 STE 200-612
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8722
Mailing Address - Country:US
Mailing Address - Phone:469-686-8195
Mailing Address - Fax:469-857-8492
Practice Address - Street 1:2455 ROBINSON RD STE 100
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-3852
Practice Address - Country:US
Practice Address - Phone:469-626-8195
Practice Address - Fax:469-857-8492
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
TXAP121985363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily