| Doctor Name: | MISS JESSICA JAMISON |
| NPI Number: | 1194871731 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PROVIDER |
| License Number: | 5319389001 |
| Business Practice Address: | 7505 Pines Rd Ste 1255 Shreveport, LA - 711293923 |
| Business Phone Number: | 3186879929 |
| Business Fax Number: | 3186879469 |
| Mailing Address: | 7505 Pines Rd Ste 1255, SHREVEPORT |
| State: | LA |
| Postal Code: | 711293923 |
| Phone Number: | 3186879929 |
| Fax Number: | 3186879469 |
| NPI Enumeration Date: | 01/26/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | 5319389001 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |