Provider Demographics
NPI:1285892851
Name:JAMIESON, LARRY
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:JAMIESON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 COUNTY ROAD 340
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:AR
Mailing Address - Zip Code:72324-8943
Mailing Address - Country:US
Mailing Address - Phone:870-588-3765
Mailing Address - Fax:
Practice Address - Street 1:113 COUNTY ROAD 340
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:AR
Practice Address - Zip Code:72324-8943
Practice Address - Country:US
Practice Address - Phone:870-588-3765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide