Derek R. Harris, MSN, APRN, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

AP07181 Issued in LA

Practice address

1919 Fairfield Ave
Shreveport, LA 71101-4436

Phone

(318) 828-2210

Fax

(318) 828-2215

NPI assigned

Feb 8, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Lsu Health Sciences Center Shreveport Faculty Group Practice

  • Family Medicine Physician
  • Shreveport, LA
  • NPI 1013374222
  Medicare reassignment NPD
• Brfhh Shreveport LLC

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1912909912
  NPD (past)
• Progressive Childrens Clinic LLC

  • Pediatrics Physician
  • Shreveport, LA
  • NPI 1942573589
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560729600000",
    "number": "1821360728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 FAIRFIELD AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014436",
            "telephone_number": "318-828-2210",
            "fax_number": "318-828-2215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 FAIRFIELD AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014436",
            "telephone_number": "318-828-2210",
            "fax_number": "318-828-2215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "DEREK",
        "middle_name": "R.",
        "credential": "MSN, APRN, CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-02-08",
        "last_updated": "2019-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "LA",
            "license": "AP07181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2330578",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Caroline Leigh Harris
• Cierra Harris
• Claudia Harris, LCSW
• Coretta Harris, RPH
• Danielle Harris, MHS
• Destiny Harris
• Diana Harris
• Donna Harris
• Elke Webb Harris, LMSW
• Gerald Holden Harris

• Pediatric Nurse Practitioner in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Pediatric Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.