Jennifer Joy Harrison

Key facts

NPI

1609519149

Entity type

Individual (NPI type 1)

Primary specialty

Developmental Therapist 222Q00000X

Practice address

107 Park St
MC Gehee, AR 71654-2915

Phone

(501) 313-3389

Fax

(501) 614-1609

NPI assigned

Apr 13, 2022

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Interoperability endpoints

• Direct secure messaging: jennifer@eagle4families.com

Specialties & licenses

Addresses

Other identifiers

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 13, 2022.

{
    "created_epoch": "1649808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649808000000",
    "number": "1609519149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3203 N COUNTY ROAD 103",
            "city": "MANILA",
            "state": "AR",
            "postal_code": "724428086",
            "telephone_number": "870-930-4132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 PARK ST",
            "city": "MC GEHEE",
            "state": "AR",
            "postal_code": "716542915",
            "telephone_number": "501-313-3389",
            "fax_number": "501-614-1609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRISON",
        "first_name": "JENNIFER",
        "middle_name": "JOY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-13",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0822",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Jennifer@eagle4families.com",
            "affiliation": "Y",
            "endpointDescription": "contracting company",
            "affiliationName": "Eagle Family Therapy Services",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "107 Park St",
            "city": "Mc Gehee",
            "state": "AR",
            "country_code": "US",
            "postal_code": "716542915",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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All providers in MC Gehee, AR · Developmental Therapist in Arkansas