Provider Demographics
NPI:1598027336
Name:HARNESS, JESSICA NICOLE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:HARNESS
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 1:2352 MEADOWS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-8419
Mailing Address - Country:US
Mailing Address - Phone:720-455-0670
Mailing Address - Fax:720-455-0671
Practice Address - Street 1:2352 MEADOWS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8419
Practice Address - Country:US
Practice Address - Phone:720-455-0670
Practice Address - Fax:720-455-0671
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0058369208D00000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice