Healthcare Provider Details

I. General information

NPI: 1588053789
Provider Name (Legal Business Name): JENNIFER HARRIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 10054
RUSSELLVILLE AR
72812-0054
US

IV. Provider business mailing address

PO BOX 10054
RUSSELLVILLE AR
72812-0054
US

V. Phone/Fax

Practice location:
  • Phone: 479-336-6642
  • Fax: 479-227-5562
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004265
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: