Provider Demographics
NPI:1740583137
Name:CLANCY, JAMIE DAVID (EMT-P, MICT)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:DAVID
Last Name:CLANCY
Suffix:
Gender:M
Credentials:EMT-P, MICT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 RAINBOW DR # 7641
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77399-1076
Mailing Address - Country:US
Mailing Address - Phone:785-845-6179
Mailing Address - Fax:
Practice Address - Street 1:176 RAINBOW DR # 7641
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77399-1076
Practice Address - Country:US
Practice Address - Phone:785-845-6179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2014-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15906146L00000X
AZ87252146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic