Provider Demographics
NPI:1225912983
Name:HARRIS, VICKEY KPANNAH
Entity type:Individual
Prefix:
First Name:VICKEY
Middle Name:KPANNAH
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 1:3841 50TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4624
Mailing Address - Country:US
Mailing Address - Phone:817-691-7829
Mailing Address - Fax:817-691-7829
Practice Address - Street 1:3841 50TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4624
Practice Address - Country:US
Practice Address - Phone:817-691-7829
Practice Address - Fax:817-691-7829
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND65621376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide