Provider Demographics
NPI:1861633315
Name:JETT, JAMIE DAWN (RN BSN MBA)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:DAWN
Last Name:JETT
Suffix:
Gender:F
Credentials:RN BSN MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8617 WOODLAKE DR
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-9349
Mailing Address - Country:US
Mailing Address - Phone:318-949-5079
Mailing Address - Fax:
Practice Address - Street 1:8617 WOODLAKE DR
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-9349
Practice Address - Country:US
Practice Address - Phone:318-949-5079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN045377163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator