Provider Demographics
NPI:1316921018
Name:JAMERSON, NANCY GAYLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:GAYLE
Last Name:JAMERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:GAYLE
Other - Last Name:DONAHOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1203 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MO
Mailing Address - Zip Code:64759-2416
Mailing Address - Country:US
Mailing Address - Phone:417-214-3966
Mailing Address - Fax:
Practice Address - Street 1:BARTON COUNTY HEALTH DEPARTMENT
Practice Address - Street 2:1301 EAST 12TH ST.
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759-6475
Practice Address - Country:US
Practice Address - Phone:417-214-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0006191041C0700X, 225XM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO753560101Medicaid
MO493560106Medicaid
MO000078705Medicare ID - Type UnspecifiedMEDICARE (ST. LOUIS)
MOL436308Medicare PIN