Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP126426 | TX |
NPI | 1043614233 |
---|---|
Provider Name | Casey Jamison |
First Address | Crossroads, TX 76227-2661 |
Second Address | Crossroads, TX 76227-2661 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2014 |
Last Update Date | 12/10/2021 |