Active NPI
Susan R. Harris, CNM, FNP-C
- Family Nurse Practitioner
- Coppell, TX
National Provider Identifier
1407912827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 625586
- Practice address
- 705 Main Street
Coppell, TX 75019-4401 - Phone
- (972) 304-6400
- Fax
- (972) 304-6455
- NPI assigned
- Dec 29, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 625586 | TX | Primary |
| Advanced Practice Midwife | 367A00000X | 625586 | TX |
Addresses
Primary practice location
705 Main Street
Coppell, TX 75019-4401
Mailing address
705 Main St
Coppell, TX 75019-4742
Phone (972) 304-6400
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 199869201 | Medicaid | TX | |
| 8Y8471 | Other | TX | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2024 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife, Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifestream Health Center PA | Past | Accepting new patients | |
| Harris 4 Health, PLLC | Family | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Nurse Practitioner
- Coppell, TX
- NPI 1326386004
-
- Specialist
- Coppell, TX
- NPI 1235363409
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436918400000",
"number": "1407912827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "705 MAIN ST",
"city": "COPPELL",
"state": "TX",
"postal_code": "750194742",
"telephone_number": "972-304-6400",
"fax_number": "972-304-6455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 MAIN STREET",
"city": "COPPELL",
"state": "TX",
"postal_code": "750194401",
"telephone_number": "972-304-6400",
"fax_number": "972-304-6455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "SUSAN",
"middle_name": "R.",
"credential": "CNM, FNP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-29",
"last_updated": "2015-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TX",
"license": "625586",
"primary": true
},
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "TX",
"license": "625586",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "199869201",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "8Y8471",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coppell, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.