Individual ProviderKelly Rae HarrisNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address16515 S 40th St Ste 135, Phoenix, AZ 85048-0560(480) 556-0446PECOS EnrollmentBased on the most recent information from CMS, provider Kelly Rae Harris does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1851753255Provider TypeIndividualFull NameHarris, Kelly RaeCredentialFNP-CGenderFemaleSole ProprietorYesEnumeration Date3/24/2016Last Updated12/18/2019Contact InformationPractice LocationPractice Address16515 S 40th St Ste 135, Phoenix, AZ 85048-0560Phone(480) 556-0446Fax(480) 556-0447Mailing LocationMailing Address20401 N 73rd St Ste 230, Scottsdale, AZ 85255-4153Phone(480) 556-0446Fax(480) 556-0447Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseAP8587ArizonaCode163W00000XDescriptionRegistered NurseNursing Service ProvidersLicenseRN173398Arizona