Provider Demographics
NPI:1497802516
Name:HARRIS, CONSUELA DENISE (DNP)
Entity type:Individual
Prefix:
First Name:CONSUELA
Middle Name:DENISE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:CONSUELA
Other - Middle Name:DENISE
Other - Last Name:WITHERSPOON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP/FNP-BC
Mailing Address - Street 1:1230 RIVER BEND DR STE 218
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4993
Mailing Address - Country:US
Mailing Address - Phone:469-401-5133
Mailing Address - Fax:
Practice Address - Street 1:2001 S MEDFORD DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-6260
Practice Address - Country:US
Practice Address - Phone:936-404-7738
Practice Address - Fax:361-579-6913
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX682737363L00000X
TXAP115509363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX682737OtherSTATE LICENSE