Provider Demographics
NPI:1861930554
Name:HARRIS, LINDA LEE (AGNP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 BENT BROOK RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-1348
Mailing Address - Country:US
Mailing Address - Phone:401-359-1558
Mailing Address - Fax:
Practice Address - Street 1:713 BENT BROOK RD
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-1348
Practice Address - Country:US
Practice Address - Phone:401-359-1558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX949785163W00000X
RIAPRN01541363LG0600X
TXAP139589363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse