Provider Demographics
NPI:1750472551
Name:KAMARA, JAMIE NDUTA (NP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:NDUTA
Last Name:KAMARA
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 1:5410 BOBTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-6654
Mailing Address - Country:US
Mailing Address - Phone:972-203-0771
Mailing Address - Fax:214-239-9980
Practice Address - Street 1:5410 BOBTOWN ROAD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75243
Practice Address - Country:US
Practice Address - Phone:972-203-0771
Practice Address - Fax:214-221-5600
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX676060363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143800405Medicaid
TXP00254691OtherRAIL ROAD MEDICARE
TXP00254691OtherRAIL ROAD MEDICARE