Provider Demographics
NPI:1740870674
Name:HARPER, JOHN BRYAN (REGISTERED NURSE)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BRYAN
Last Name:HARPER
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5886 T K CULPEPPER RD
Mailing Address - Street 2:
Mailing Address - City:TOOMSUBA
Mailing Address - State:MS
Mailing Address - Zip Code:39364-9609
Mailing Address - Country:US
Mailing Address - Phone:601-701-4868
Mailing Address - Fax:
Practice Address - Street 1:5886 T K CULPEPPER RD
Practice Address - Street 2:
Practice Address - City:TOOMSUBA
Practice Address - State:MS
Practice Address - Zip Code:39364-9609
Practice Address - Country:US
Practice Address - Phone:601-701-4868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR850772163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty