Healthcare Provider Details

I. General information

NPI: 1285429498
Provider Name (Legal Business Name): JENNIFER C HARMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 N BUFFALO BILL AVE
NORTH PLATTE NE
69101-2619
US

IV. Provider business mailing address

1705 N BUFFALO BILL AVE
NORTH PLATTE NE
69101-2619
US

V. Phone/Fax

Practice location:
  • Phone: 308-539-4267
  • Fax:
Mailing address:
  • Phone: 308-539-4267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: