Provider Demographics
NPI:1114807088
Name:GAUNTT, JAMISEN JEWELL
Entity type:Individual
Prefix:MS
First Name:JAMISEN
Middle Name:JEWELL
Last Name:GAUNTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMISEN
Other - Middle Name:
Other - Last Name:DILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:101 SHADY PARK LN
Mailing Address - Street 2:
Mailing Address - City:BONO
Mailing Address - State:AR
Mailing Address - Zip Code:72416-9581
Mailing Address - Country:US
Mailing Address - Phone:870-586-3368
Mailing Address - Fax:
Practice Address - Street 1:101 SHADY PARK LN
Practice Address - Street 2:
Practice Address - City:BONO
Practice Address - State:AR
Practice Address - Zip Code:72416-9581
Practice Address - Country:US
Practice Address - Phone:870-586-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR50382081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine