Provider Demographics
NPI:1235584723
Name:HARPER, JACKLEN
Entity Type:Individual
Prefix:
First Name:JACKLEN
Middle Name:
Last Name:HARPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 DOGWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6641
Mailing Address - Country:US
Mailing Address - Phone:601-813-1045
Mailing Address - Fax:601-398-3911
Practice Address - Street 1:171 DOGWOOD CIR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-6641
Practice Address - Country:US
Practice Address - Phone:601-813-1045
Practice Address - Fax:601-398-3911
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care