Mindy Harris, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71007377A Issued in IN

Practice address

11143 Parkview Plaza Dr
Fort Wayne, IN 46845-1727

Phone

(260) 425-6330

NPI assigned

Jul 3, 2017

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1499040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525046400000",
    "number": "1871014589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15133 LIONS PSGE",
            "city": "LEO",
            "state": "IN",
            "postal_code": "467659597",
            "telephone_number": "260-341-2397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11143 PARKVIEW PLAZA DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451727",
            "telephone_number": "260-425-6330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "MINDY",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-03",
        "last_updated": "2018-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71007377A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871523787",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jaquelle Harris, RBT
• Jeffrey L Harris, MD
• Jessica Elaine Harris
• Julianne Lisa Harris, RPH
• Laketia Arnet Harris
• Miranda Harris
• Sebastian M Harris, MD
• Harrison Dental Group I LLC
• Harrison Dental Group II, LLC
• Harrison Dental Group III LLC

• Family Nurse Practitioner in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.