Provider Demographics
NPI:1700226107
Name:HARRISON, JESSICA MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 COMMERCE AVENUE
Mailing Address - Street 2:SUITE 289 B
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-2346
Mailing Address - Country:US
Mailing Address - Phone:706-416-7837
Mailing Address - Fax:
Practice Address - Street 1:102 MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3225
Practice Address - Country:US
Practice Address - Phone:706-416-7837
Practice Address - Fax:888-855-7157
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN198333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily