Doctor Name: | KENDA MARSHELLE HARRISON |
NPI Number: | 1043565617 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 16821 |
Business Practice Address: | 1701 N Main St Suite E Shelbyville, TN - 371602303 |
Business Phone Number: | 9316859000 |
Business Fax Number: | |
Mailing Address: | 116 Carlisle Ave, SHELBYVILLE |
State: | TN |
Postal Code: | 371603812 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/19/2012 |
NPI Last Update Date: | 01/07/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 16821 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |