Provider Demographics
NPI:1093830440
Name:JAMISON, MARCIA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:ANN
Last Name:JAMISON
Suffix:
Gender:F
Credentials:PA-C
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 6310
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88006-6310
Mailing Address - Country:US
Mailing Address - Phone:575-556-5960
Mailing Address - Fax:575-556-5959
Practice Address - Street 1:2530 S TELSHOR BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4951
Practice Address - Country:US
Practice Address - Phone:575-522-6806
Practice Address - Fax:575-521-8033
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM93-PA03363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP00905170OtherRR MEDICARE
NM000097651Medicaid
NMP00905170OtherRR MEDICARE
NMR014-0260Medicare UPIN