Healthcare Provider Details

I. General information

NPI: 1942970710
Provider Name (Legal Business Name): JESSICA J HARRIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 WAMPANOAG TRL STE 9
RIVERSIDE RI
02915-1217
US

IV. Provider business mailing address

1275 WAMPANOAG TRL STE 9
RIVERSIDE RI
02915-1217
US

V. Phone/Fax

Practice location:
  • Phone: 401-352-8440
  • Fax:
Mailing address:
  • Phone: 401-352-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN03567
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN64505
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: