Provider Demographics
NPI:1265929624
Name:JAMISON, DARA
Entity type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:JAMISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 LOWER WHITE OAK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTSMOUTH
Mailing Address - State:KY
Mailing Address - Zip Code:41174-8938
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 OFFNERE ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4655
Practice Address - Country:US
Practice Address - Phone:740-876-9369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator