Provider Demographics
NPI:1437847266
Name:HARRIS, KAWANZA KAMILL
Entity type:Individual
Prefix:
First Name:KAWANZA
Middle Name:KAMILL
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4975
Mailing Address - Country:US
Mailing Address - Phone:469-612-4103
Mailing Address - Fax:
Practice Address - Street 1:502 N HAMPTON RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4975
Practice Address - Country:US
Practice Address - Phone:469-612-4103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies