Provider Demographics
NPI:1801391149
Name:HARRIS, JESSICA L (LVN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 BAYBERRY CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-3423
Mailing Address - Country:US
Mailing Address - Phone:940-782-8901
Mailing Address - Fax:
Practice Address - Street 1:14 BAYBERRY CT
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-3423
Practice Address - Country:US
Practice Address - Phone:940-782-8901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX327189164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse