Healthcare Provider Details

I. General information

NPI: 1295547222
Provider Name (Legal Business Name): JEN'BRICA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2352 E VILLAGE CT
GRETNA LA
70056-4624
US

IV. Provider business mailing address

2000 CANAL ST
NEW ORLEANS LA
70112-3018
US

V. Phone/Fax

Practice location:
  • Phone: 504-259-4225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number211013
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: