Provider Demographics
NPI:1508330838
Name:UNDERHILL, JAMIE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
Last Name:UNDERHILL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 SOUTH FWY STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-1407
Mailing Address - Country:US
Mailing Address - Phone:817-750-7334
Mailing Address - Fax:817-910-6120
Practice Address - Street 1:4200 SOUTH FWY STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-1407
Practice Address - Country:US
Practice Address - Phone:817-750-7334
Practice Address - Fax:817-910-6120
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX669577363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily