1083079453 NPI number — MS. DALLARIE JAMISON CRNP

Table of content: MS. DALLARIE JAMISON CRNP (NPI 1083079453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083079453 NPI number — MS. DALLARIE JAMISON CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAMISON
Provider First Name:
DALLARIE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083079453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36304-0308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-673-8869
Provider Business Mailing Address Fax Number:
334-673-8851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 REGENCY CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36305-1179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-673-8869
Provider Business Practice Location Address Fax Number:
334-673-8851
Provider Enumeration Date:
12/29/2015

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: 2084P0800X , with the licence number:  RN209490 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 9475102 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0805X , with the licence number: 1-127798 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0805X , with the licence number: RN209490 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0805X , with the licence number: 9475102 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 1-127798 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: RN209490 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 9475102 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: CP.17240 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0348462 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 188102 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19C1R . This is a "NEW DIRECTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 601701400 . This is a "DOL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003194200C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010838800 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 407098142C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 774089000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010838800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51521565 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 523314 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1083079453 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 229432 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q6YNL . This is a "FLORIDA BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1080690 . This is a "BEACON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1013117167 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13804050 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 205760 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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