Provider Demographics
NPI:1609253921
Name:HUME, JAMIE ROSE (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ROSE
Last Name:HUME
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 ENTERPRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-9711
Mailing Address - Country:US
Mailing Address - Phone:580-554-2395
Mailing Address - Fax:
Practice Address - Street 1:5110 ENTERPRISE BLVD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-9711
Practice Address - Country:US
Practice Address - Phone:580-554-2395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer