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NPI Code Detail

MEDICARE: MRS. JUDY KATHERYN JAMISON RN

MEDICARE: MRS. JUDY KATHERYN JAMISON RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse71354MO

General Provider Information

NPI Number : 1124029632
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JUDY KATHERYN JAMISON RN
Provider Business Mailing Address
First Line : 5471 DR MARTIN LUTHER KING DR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63112-4265
Country : US
Telephone Number : 314-367-5820
Fax Number : 314-367-7010
Provider Business Practice Location Address
First Line : 5471 DR MARTIN LUTHER KING DR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63112-4265
Country : US
Telephone Number : 314-367-5820
Fax Number : 314-367-7010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 07/08/2007

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Directions to “ MRS. JUDY KATHERYN JAMISON RN” Practice Location

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