Active NPI
Jacqueline Harrison
- Family Medicine Physician
- Overland Park, KS
National Provider Identifier
1295140267
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 04-40188
- Practice address
- 4061 Indian Creek Pkwy
Overland Park, KS 66207-4030 - Phone
- (913) 323-4600
- Fax
- (913) 323-4748
- NPI assigned
- Jun 27, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 04-40188 | KS | Primary |
Addresses
Primary practice location
4061 Indian Creek Pkwy
Overland Park, KS 66207-4030
Mailing address
901 E. 104TH St.
Mailstop 400N
Kansas City, MO 64131-9712
Phone (816) 502-7104
Other practice location 1
14700 E Old US Highway 12
Chelsea, MI 48118-1185
Phone (734) 475-4452
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04-40188 | KS | MD | Family Medicine Physician |
Interoperability endpoints
- jacqueline.harrison@5214483447812.direct.elationemr.com
- https://fhir4.healow.com/fhir/r4/EAAFBA/Endpoint/EAAFBA
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1518652800000",
"number": "1295140267",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 E. 104TH ST.",
"address_2": "MAILSTOP 400N",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641319712",
"telephone_number": "816-502-7104",
"fax_number": "816-932-9670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4061 INDIAN CREEK PKWY",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662074030",
"telephone_number": "913-323-4600",
"fax_number": "913-323-4748"
}
],
"practiceLocations": [
{
"address_1": "14700 E Old US Highway 12",
"address_purpose": "LOCATION",
"city": "Chelsea",
"state": "MI",
"postal_code": "481181185",
"country_code": "US",
"telephone_number": "734-475-4452",
"fax_number": "734-433-3151",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HARRISON",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-06-27",
"last_updated": "2018-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "KS",
"license": "04-40188",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Overland Park, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.