Healthcare Provider Details

I. General information

NPI: 1912406182
Provider Name (Legal Business Name): JAMEY ADAMS RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12332 SHALE DR
FORT WORTH TX
76244-7501
US

IV. Provider business mailing address

12332 SHALE DR
FORT WORTH TX
76244-7501
US

V. Phone/Fax

Practice location:
  • Phone: 817-915-5718
  • Fax:
Mailing address:
  • Phone: 817-915-5718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License Number74564
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: