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General NPI Number Information
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NPI Number | 1538370291
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Entity Type | Individual
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Provider Name | JACQULENE HARRIS FNP
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 01/07/2019
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Provider Practice Location Address
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Address Line | 1412 N 2ND ST
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City | ATCHISON
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State | KS
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Zip | 66002-1203
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Country | US
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Telephone | 913-367-4879
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Fax | 913-367-0240
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Provider Business Mailing Address
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Address Line | 1412 N 2ND ST
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City | ATCHISON
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State | KS
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Zip | 66002-1203
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Country | US
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Telephone | 913-367-4879
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Fax | 913-367-0240
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 45573
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License Number State | KS
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