Provider Demographics
NPI:1114258779
Name:HARRISON, JESSE JERMAINE (CST)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:JERMAINE
Last Name:HARRISON
Suffix:
Gender:M
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17915 GLEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-9582
Mailing Address - Country:US
Mailing Address - Phone:225-275-3866
Mailing Address - Fax:
Practice Address - Street 1:17915 GLEN PARK DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-9582
Practice Address - Country:US
Practice Address - Phone:225-275-3866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist