Provider Demographics
NPI:1083079453
Name:JAMISON, DALLARIE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:DALLARIE
Middle Name:
Last Name:JAMISON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8308
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36304-0308
Mailing Address - Country:US
Mailing Address - Phone:334-673-8869
Mailing Address - Fax:334-673-8851
Practice Address - Street 1:201 REGENCY CT
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1179
Practice Address - Country:US
Practice Address - Phone:334-673-8869
Practice Address - Fax:334-673-8851
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN2094902084P0800X, 2084P0805X, 363L00000X
FL94751022084P0800X, 2084P0805X, 363L00000X
AL1-1277982084P0805X, 363L00000X
ALCP.172402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
0348462OtherCIGNA
AL188102Medicaid
19C1ROtherNEW DIRECTIONS
601701400OtherDOL
GA003194200CMedicaid
AL010838800Medicaid
GA407098142CMedicaid
774089000OtherMAGELLAN
FL010838800Medicaid
AL51521565OtherBCBS
523314OtherVALUE OPTIONS
1083079453OtherNPI
AL229432Medicaid
Q6YNLOtherFLORIDA BLUE
1080690OtherBEACON
1013117167OtherNPI
13804050OtherCAQH
AL205760Medicaid