Provider Demographics
NPI:1922674027
Name:HARRELL, JESSICA LYNNE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:HARRELL
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 MERCER LN
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-5882
Mailing Address - Country:US
Mailing Address - Phone:678-986-0921
Mailing Address - Fax:
Practice Address - Street 1:186 MERCER LN
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-5882
Practice Address - Country:US
Practice Address - Phone:678-986-0921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN209261163WP1700X, 163WM0102X, 163WX0002X, 163WX0003X
GARN20921163WN0003X
GAL-120671163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WP1700XNursing Service ProvidersRegistered NursePerinatal
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient