Provider Demographics
NPI:1700036621
Name:KOONCE, JAMIE (DACM, LAC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:KOONCE
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 OAKLAND HILLS TER
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-9076
Mailing Address - Country:US
Mailing Address - Phone:501-538-4227
Mailing Address - Fax:
Practice Address - Street 1:115 OAKLAND HILLS TER
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-9076
Practice Address - Country:US
Practice Address - Phone:501-538-4227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-27
Last Update Date:2016-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0627171100000X
AR050171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist