Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 0024169243 | VA |
NPI | 1023316940 |
---|---|
Provider Name | Ms. Jessica Mary Harris |
First Address | Fredericksburg, VA 22408-7760 |
Second Address | Fredericksburg, VA 22408-7760 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2011 |
Last Update Date | 03/01/2013 |