Individual
JACQUELINE HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
800 5TH AVE STE 300, FORT WORTH, TX 76104-7303
(817) 878-5300
(817) 878-5321
Mailing address
800 5TH AVE STE 300, FORT WORTH, TX 76104-7303
(817) 878-5300
(817) 878-5321
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA03245
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1821016403
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/18/2006
Last updated
09/09/2019
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