Individual provider Active NPI

Jennifer Lynn Harris, NP

  • Pediatric Nurse Practitioner
  • College Station, TX
National Provider Identifier
1962754960
Registry record updated Jul 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
AP12181 Issued in TX
Practice address
800 Scott and White Dr
College Station, TX 77845-6440
Phone
(979) 207-4000
NPI assigned
Oct 15, 2012
Last updated
Jul 30, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 676219 TX
Pediatric Nurse Practitioner 363LP0200X AP12181 TX Primary

Addresses

Primary practice location

800 Scott and White Dr
College Station, TX 77845-6440

Mailing address

PO Box 844658
Dallas, TX 75284-4658

Other practice location 1

9701 N Sam Houston Pkwy E
Suite 170
Humble, TX 77396-4636
Phone (281) 441-6900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130829000101 TX Practitioner - Nurse Practitioner 4183867732 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
676219TXMDPediatric Nurse Practitioner
AP12181TXMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Scott & White Clinic Current Accepting new patients
TCH Pediatric Associates, Inc Past Accepting new patients
Scott & White Hospital - Taylor Past Accepting new patients

Locations

1700 University Dr E
College Station, TX 77840
Phone (979) 691-3300

1700 University Dr E
Fl 2
College Station, TX 77840
Phone (979) 361-3300

2401 S 31st St
Temple, TX 76508
Phone (254) 724-2459

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532908800000",
    "number": "1962754960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 SCOTT AND WHITE DR",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778456440",
            "telephone_number": "979-207-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9701 N Sam Houston Pkwy E",
            "address_2": "SUITE 170",
            "address_purpose": "LOCATION",
            "city": "Humble",
            "state": "TX",
            "postal_code": "773964636",
            "country_code": "US",
            "telephone_number": "281-441-6900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-15",
        "last_updated": "2018-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TX",
            "license": "676219",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TX",
            "license": "AP12181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in College Station, TX

Sources for this page

Verify at the official NPI Registry.