Healthcare Provider Details

I. General information

NPI: 1093472219
Provider Name (Legal Business Name): JALEESA HARRIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JALEESA JOHNSON

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CENTER ST
MOBILE AL
36604-1541
US

IV. Provider business mailing address

PO BOX 746450
ATLANTA GA
30374-6450
US

V. Phone/Fax

Practice location:
  • Phone: 251-660-5108
  • Fax:
Mailing address:
  • Phone: 866-401-3057
  • Fax: 318-868-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016628
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-182058
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number223825
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: