Provider Demographics
NPI:1609695543
Name:PHARRIS, QUANITA LATRESE (FNP-C)
Entity type:Individual
Prefix:
First Name:QUANITA
Middle Name:LATRESE
Last Name:PHARRIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5124 MEADOW LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35020-8125
Mailing Address - Country:US
Mailing Address - Phone:205-276-4661
Mailing Address - Fax:
Practice Address - Street 1:3800 RIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5506
Practice Address - Country:US
Practice Address - Phone:205-868-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-144868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily