Healthcare Provider Details

I. General information

NPI: 1184391450
Provider Name (Legal Business Name): BRIDGETT DIONE JAMISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12700 E 100TH ST N APT 20105
OWASSO OK
74055-9336
US

IV. Provider business mailing address

12700 E 100TH ST N APT 20105
OWASSO OK
74055-9336
US

V. Phone/Fax

Practice location:
  • Phone: 214-924-8766
  • Fax:
Mailing address:
  • Phone: 214-924-8766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20709
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116514
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: