Provider Demographics
NPI:1669088639
Name:HARRIS, ZOEY JADE
Entity type:Individual
Prefix:
First Name:ZOEY
Middle Name:JADE
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 1:14 CASH LN
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-1474
Mailing Address - Country:US
Mailing Address - Phone:304-790-9598
Mailing Address - Fax:
Practice Address - Street 1:14 CASH LN
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-1474
Practice Address - Country:US
Practice Address - Phone:304-790-9598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant