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General NPI Number Information
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NPI Number | 1023661311
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Entity Type | Individual
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Provider Name | KELLY JAMISON FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 13295 BUSINESS 331 BLDG A SUITE 300
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City | FREEPORT
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State | FL
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Zip | 32439
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Country | US
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Telephone | 850-924-8004
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Fax |
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Provider Business Mailing Address
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Address Line | 257 MILL POND CV
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City | FREEPORT
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State | FL
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Zip | 32439-7650
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Country | US
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Telephone | 229-834-0585
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 56976
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11014678
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License Number State | FL
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