Provider Demographics
NPI:1720617723
Name:LABORN, CHARRISSA JANE
Entity Type:Individual
Prefix:MS
First Name:CHARRISSA
Middle Name:JANE
Last Name:LABORN
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 1:109 NW MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-4079
Mailing Address - Country:US
Mailing Address - Phone:214-608-7373
Mailing Address - Fax:
Practice Address - Street 1:109 NW MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-4079
Practice Address - Country:US
Practice Address - Phone:214-608-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171R00000XOther Service ProvidersInterpreter
No172A00000XOther Service ProvidersDriver
No172M00000XOther Service ProvidersMechanotherapist
No172V00000XOther Service ProvidersCommunity Health Worker
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program