Provider Demographics
NPI:1851713606
Name:HARRIS, JESSICA ROSETTE
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ROSETTE
Last Name:HARRIS
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 1:2817 DEL RIO PLACE
Mailing Address - Street 2:COMMON GROUND
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220
Mailing Address - Country:US
Mailing Address - Phone:502-451-1148
Mailing Address - Fax:502-451-8153
Practice Address - Street 1:2817 DEL RIO PLACE
Practice Address - Street 2:COMMON GROUND
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220
Practice Address - Country:US
Practice Address - Phone:502-451-1148
Practice Address - Fax:502-451-8153
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker