Jacqueline K Harris, ARNP
Individual provider Active NPI Family Nurse Practitioner · Montezuma, IA
NPI 1962485813 · NPPES record last updated Nov 13, 2023
Key facts
- NPI
- 1962485813
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- A093734 (IA)
- Practice address
- 101 W Washington St
Montezuma, IA 50171-7739 - Phone
- (641) 623-5690
- NPI assigned
- Nov 23, 2005
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110218000761 | IA | Practitioner - Nurse Practitioner | 2668653940 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A093734 | IA | MD | Acute Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Luke'S Methodist Hospital | Current | Accepting new patients | |
| Grinnell Regional Medical Center | Family | Current |
Accepting new patients |
| Grinnell Regional Medical Center | Past | Accepting new patients | |
| Grinnell Regional Medical Center | Past | Accepting new patients |
Locations
210 4th Ave
Grinnell, IA 50112
Phone (641) 236-2055
101 W Washington St
Montezuma, IA 50171
Phone (641) 623-5690
101 W Washington St
Ste 100
Montezuma, IA 50171
Phone (641) 623-5690
Interoperability endpoints
- jharris826366@direct.unitypoint.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | A093734 | IA | Yes |
| Acute Care Nurse Practitioner | 363LA2100X | A093734 | IA |
Addresses
Primary practice location
101 W Washington St
Montezuma, IA 50171-7739
Mailing address
PO Box 430
Montezuma, IA 50171-0430
Phone (641) 623-5690
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962485813 | Medicaid | IA |
Other providers in Montezuma, IA
- Diamond Life Health Care, Inc.
- Diamond Trail Dental PC
- Sara Erselius
- Grinnell Regional Medical Center
- GRX Holdings LLC
- Heartland Pediatric Feeding Disorders Services
- Melinda Sue McNaul
- Monte Pharmacies LLC
- Montezuma Community School District
- Montezuma Smiles
All providers in Montezuma, IA · Family Nurse Practitioner in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.