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General NPI Number Information
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NPI Number | 1104293018
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Entity Type | Individual
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Provider Name | JILLIAN HARRIS
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Gender | Female
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Dates
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Enumeration Date | 08/26/2015
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 1605 2ND ST
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City | EARLE
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State | AR
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Zip | 72331-1634
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Country | US
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Telephone | 870-633-8825
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Fax |
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Provider Business Mailing Address
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Address Line | 332 E COOK ST
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City | FORREST CITY
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State | AR
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Zip | 72335-2830
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | A004527
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License Number State | AR
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