Provider Demographics
NPI:1962453043
Name:HARRIS, JASON (FNP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3677
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03061-3677
Mailing Address - Country:US
Mailing Address - Phone:603-577-7900
Mailing Address - Fax:603-577-7972
Practice Address - Street 1:33 WINDHAM RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NH
Practice Address - Zip Code:03076-2372
Practice Address - Country:US
Practice Address - Phone:603-577-2273
Practice Address - Fax:603-635-5441
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA236916363L00000X
NH056047-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH40Y013345NH01OtherANTHEM BCBS
NHP00697980OtherRAILROAD MCARE THRU SEACOAST
NH30346481Medicaid
ME433002799Medicaid
ME433002799Medicaid