Provider Demographics
NPI:1710179247
Name:JAMESON, JESSIE JANEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:JANEL
Last Name:JAMESON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JESSIE
Other - Middle Name:JANEL
Other - Last Name:SOUTHERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1010 THREE SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-8296
Mailing Address - Country:US
Mailing Address - Phone:970-764-3207
Mailing Address - Fax:970-764-3789
Practice Address - Street 1:1010 THREE SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-8296
Practice Address - Country:US
Practice Address - Phone:970-764-3207
Practice Address - Fax:970-764-3789
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104975207L00000X, 207LC0200X
NMMD2012-0427207L00000X, 207LC0200X
390200000X
CO55897207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO31934269Medicaid