ANDRELENA HARRIS (NPI# 1023629227) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023629227 |
| Entity Type | Individual |
| Full Name | ANDRELENA HARRIS |
| Credential | LPN |
| Practice Address |
121 Tillis Dr Pinola MS 39149-3165 |
| Practice Telephone | 6018671247 |
| Mailing Telephone | 6018671247 |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2020-08-11 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3747P1801X |
Technician Specialization: Personal Care Attendant |
Nursing Service Related Providers |
| Street Address |
121 TILLIS DR |
| City | PINOLA |
| State | MS |
| Zip Code | 39149-3165 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952534505 | Family Health Care Clinic, Inc. | Clinic/Center | 592 Schoolhouse Rd, Pinola, MS 39149 | 2009-08-31 |
| 1407300957 | Lashanda Carter | Community Health Worker | 283 Hollins Rd, Pinola, MS 39149-3060 | 2016-08-12 |
| 1508230822 | Anita Bethea | Licensed Vocational Nurse | 168 Old Highway 13, Pinola, MS 39149-3813 | 2015-11-24 |
| 1902354020 | Compassionate Health Care LLC | Nursing Care | 168 Old Highway 13, Pinola, MS 39149-3813 | 2016-09-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407300957 | Lashanda Carter | Community Health Worker | 283 Hollins Rd, Pinola, MS 39149-3060 | 2016-08-12 |
| 1508230822 | Anita Bethea | Licensed Vocational Nurse | 168 Old Highway 13, Pinola, MS 39149-3813 | 2015-11-24 |
| 1952534505 | Family Health Care Clinic, Inc. | Clinic/Center | 592 Schoolhouse Rd, Pinola, MS 39149 | 2009-08-31 |
| 1902354020 | Compassionate Health Care LLC | Nursing Care | 168 Old Highway 13, Pinola, MS 39149-3813 | 2016-09-19 |
| Taxonomy Code | 3747P1801X |
| Grouping | Nursing Service Related Providers |
| Classification | Technician |
| Specialization | Personal Care Attendant |
| An individual who provides assistance with eating, bathing, dressing, personal hygiene, activities of daily living as specified in the plan of care. Services which are incidental to the care furnished, or essential to the health and welfare of the individual may also be provided. Personal care providers must meet state defined training and certification standards |
| Notes: [7/1/2003: definition added] |
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| 1164063376 | Reginald Lumpkin | Technician | 1160 Joanne St Apt 108, Jackson, MS 39204-5253 | 2019-09-30 |
| 1275181901 | Brenda Joyce Nicholson | Technician | 1677 Camp Eight Rd, Richton, MS 39476-8932 | 2019-08-27 |
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| 1851874994 | P-cares Medical Supplies, LLC | Technician | 3476 River Rd, Fayette, MS 39069-4602 | 2018-09-14 |
| 1023502804 | Beverly Clay | Technician | 6063 Fisher Rd, Meridian, MS 39301-9395 | 2018-06-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.