Provider Demographics
NPI:1356011696
Name:HARRIS, KAYSHAUN
Entity type:Individual
Prefix:
First Name:KAYSHAUN
Middle Name:
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 1:10574 LAKE HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-3788
Mailing Address - Country:US
Mailing Address - Phone:904-866-9063
Mailing Address - Fax:904-866-9063
Practice Address - Street 1:10574 LAKE HOLLOW LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-3788
Practice Address - Country:US
Practice Address - Phone:904-866-9063
Practice Address - Fax:904-866-9063
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider