Provider Demographics
NPI:1770380511
Name:HARRIS, VERN KENNY JR
Entity type:Individual
Prefix:MR
First Name:VERN
Middle Name:KENNY
Last Name:HARRIS
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 VILLA DR APT 11
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-4860
Mailing Address - Country:US
Mailing Address - Phone:308-296-1087
Mailing Address - Fax:
Practice Address - Street 1:67 VILLA DR APT 11
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-4860
Practice Address - Country:US
Practice Address - Phone:308-296-1087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist