Provider Demographics
NPI:1659965515
Name:HARR, JESSICA LYNNE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:HARR
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 1:1037 VIRGINIA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-3652
Mailing Address - Country:US
Mailing Address - Phone:304-816-2243
Mailing Address - Fax:
Practice Address - Street 1:1037 VIRGINIA AVE APT 1
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-3652
Practice Address - Country:US
Practice Address - Phone:304-816-2243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant