Provider Demographics
NPI:1457158925
Name:HARVILL, JEREMY ROBERT
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:ROBERT
Last Name:HARVILL
Suffix:
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:PO BOX 56478
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-1478
Mailing Address - Country:US
Mailing Address - Phone:907-322-0526
Mailing Address - Fax:
Practice Address - Street 1:3741 CHRISTIE DR
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-6650
Practice Address - Country:US
Practice Address - Phone:907-799-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker