MEDICARE: JEREL KEITH HARRIS NP-C

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	363LA2100X	Acute Care Nurse Practitioner	RN165803	GA

General Provider Information

NPI Number	:	1750843876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREL KEITH HARRIS NP-C

Provider Business Mailing Address
First Line	:	1677 ARCHER ESTATES DR NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30152-8101
Country	:	US
Telephone Number	:	478-228-8506
Fax Number	:

Provider Business Practice Location Address
First Line	:	1677 ARCHER ESTATES DR NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30152-8101
Country	:	US
Telephone Number	:	478-228-8506
Fax Number	:

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

Provider Enumeration Date	:	04/06/2019
Last Update Date	:	02/23/2026

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