Provider Demographics
NPI:1164319299
Name:HARRIS, JOHNNIE REBBECCA (PHD, MSN/MHA, RN)
Entity type:Individual
Prefix:DR
First Name:JOHNNIE
Middle Name:REBBECCA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHD, MSN/MHA, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 COUNTY ROAD 16500
Mailing Address - Street 2:
Mailing Address - City:DEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:75435-5217
Mailing Address - Country:US
Mailing Address - Phone:903-401-9123
Mailing Address - Fax:
Practice Address - Street 1:4510 STONEWALL ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5952
Practice Address - Country:US
Practice Address - Phone:903-401-9123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX660676163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care