MEDICARE: MS. JENNIFER RAE HARRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1578131025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER RAE HARRIS

Provider Business Mailing Address
First Line	:	2955 STATE HIGHWAY 135 N
Second Line	:
City	:	JACKSONVILLE
State	:	TX
Zip	:	75766-6809
Country	:	US
Telephone Number	:	903-721-1435
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 COUNTY ROAD 1432
Second Line	:
City	:	JACKSONVILLE
State	:	TX
Zip	:	75766-9001
Country	:	US
Telephone Number	:	903-586-4393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2021
Last Update Date	:	06/17/2021

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