Healthcare Provider Details

I. General information

NPI: 1669364402
Provider Name (Legal Business Name): JAMMIE LYNN FARISH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMMIE GARDNER

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 J ST
SACRAMENTO CA
95811-3010
US

IV. Provider business mailing address

15660 W JASPER WAY
SURPRISE AZ
85374-5026
US

V. Phone/Fax

Practice location:
  • Phone: 503-730-9943
  • Fax:
Mailing address:
  • Phone: 503-730-9943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: