Provider Demographics
NPI:1770560716
Name:HARRIS, JENNIFER KAY (ARNP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:KAY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-1916
Mailing Address - Country:US
Mailing Address - Phone:606-678-4761
Mailing Address - Fax:606-676-9671
Practice Address - Street 1:500 BOURNE AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-1916
Practice Address - Country:US
Practice Address - Phone:606-678-4761
Practice Address - Fax:606-676-9671
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2728P363LW0102X
KY1044075363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1295923183OtherPREVENTIVE HEATLH MEDICAID NPI #
KY20027017Medicaid
KY20074019Medicaid
KY20104014Medicaid
KY20001012Medicaid
KY20029013Medicaid
KY20116018Medicaid
KY20100012Medicaid
KY20023016Medicaid
KY20901211Medicaid
KY20104014Medicaid
KYM400019959Medicare PIN
Q15662Medicare UPIN
KY20901211Medicaid
KYM400019963Medicare PIN
KY20074019Medicaid
KY300613Medicare PIN
KY20100012Medicaid
KYM400019961Medicare PIN
KY1295923183OtherPREVENTIVE HEATLH MEDICAID NPI #
KYM400019958Medicare PIN