Active NPI
Jay Edward Harris, RN, MSN
- Administrator Registered Nurse
- Bend, OR
National Provider Identifier
1407160286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Administrator Registered Nurse
- License
- 200341738
- Practice address
- 1058 NE 12TH St
Bend, OR 97701-4412 - Phone
- (541) 530-3066
- NPI assigned
- Aug 3, 2010
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Administrator Registered Nurse | 163WA2000X | 200341738 | OR | Primary |
Addresses
Primary practice location
1058 NE 12TH St
Bend, OR 97701-4412
Mailing address
1058 NE 12TH St
Bend, OR 97701-4412
Phone (541) 530-3066
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200341738 | Other | OR | OREGON NURSING LICENSE |
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)
- Not enrolled
- Credentials
- Master of Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 200341738 | OR | MD | Administrator Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280793600000",
"number": "1407160286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1058 NE 12TH ST",
"city": "BEND",
"state": "OR",
"postal_code": "977014412",
"telephone_number": "541-530-3066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1058 NE 12TH ST",
"city": "BEND",
"state": "OR",
"postal_code": "977014412",
"telephone_number": "541-530-3066"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "JAY",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"credential": "RN, MSN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-08-03",
"last_updated": "2010-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "163WA2000X",
"taxonomy_group": "",
"desc": "Registered Nurse, Administrator",
"state": "OR",
"license": "200341738",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OREGON NURSING LICENSE",
"identifier": "200341738",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.