Provider Demographics
NPI:1760455018
Name:JAMISON, KAREN M (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:JAMISON
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 1:2632 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-1339
Mailing Address - Country:US
Mailing Address - Phone:602-604-5029
Mailing Address - Fax:602-240-6177
Practice Address - Street 1:2632 N 20TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-1339
Practice Address - Country:US
Practice Address - Phone:602-604-5029
Practice Address - Fax:602-240-6177
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP0232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ623878Medicaid
AZ623878Medicaid