1316921018 NPI number — MRS. NANCY GAYLE JAMERSON LCSW

Table of content: MRS. NANCY GAYLE JAMERSON LCSW (NPI 1316921018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316921018 NPI number — MRS. NANCY GAYLE JAMERSON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAMERSON
Provider First Name:
NANCY
Provider Middle Name:
GAYLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DONAHOO
Provider Other First Name:
NANCY
Provider Other Middle Name:
GAYLE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316921018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1203 E 18TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAMAR
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64759-2416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-214-3966
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BARTON COUNTY HEALTH DEPARTMENT
Provider Second Line Business Practice Location Address:
1301 EAST 12TH ST.
Provider Business Practice Location Address City Name:
LAMAR
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64759-6475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-214-3966
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  000619 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XM0800X , with the licence number: 000619 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 000619 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)