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General NPI Number Information
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NPI Number | 1285110981
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Entity Type | Individual
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Provider Name | JENNA C HARRIS
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Gender | Female
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 2507 CHESTER BLVD SPC B
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City | RICHMOND
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State | IN
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Zip | 47374-1105
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Country | US
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Telephone | 765-935-8877
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 REID PKWY
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City | RICHMOND
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State | IN
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Zip | 47374-1157
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Country | US
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Telephone | 765-983-3127
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.005495RX
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10002544A
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License Number State | IN
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