Provider Demographics
NPI:1144082686
Name:HARRIS, JERICA S
Entity type:Individual
Prefix:
First Name:JERICA
Middle Name:S
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 1:411 COUNTY ROAD 501
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-8686
Mailing Address - Country:US
Mailing Address - Phone:256-616-1936
Mailing Address - Fax:
Practice Address - Street 1:411 COUNTY ROAD 501
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-8686
Practice Address - Country:US
Practice Address - Phone:256-616-1936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care