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General NPI Number Information
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NPI Number | 1083079453
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Entity Type | Individual
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Provider Name | DALLARIE JAMISON CRNP
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Gender | Female
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Dates
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Enumeration Date | 12/29/2015
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 201 REGENCY CT
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City | DOTHAN
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State | AL
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Zip | 36305-1179
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Country | US
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Telephone | 334-673-8869
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Fax | 334-673-8851
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Provider Business Mailing Address
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Address Line | PO BOX 8308
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City | DOTHAN
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State | AL
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Zip | 36304-0308
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Country | US
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Telephone | 334-673-8869
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Fax | 334-673-8851
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | RN209490
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 9475102
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 1-127798
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | RN209490
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 9475102
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-127798
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License Number State | AL
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Taxonomy #7
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN209490
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License Number State | GA
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Taxonomy #8
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 9475102
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License Number State | FL
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Taxonomy #9
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | CP.17240
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License Number State | AL
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