Provider Demographics
NPI:1528803996
Name:JAMESON, SELENA MICHELLE
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:MICHELLE
Last Name:JAMESON
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 1:1242 TOUSLEY DR
Mailing Address - Street 2:
Mailing Address - City:OLLA
Mailing Address - State:LA
Mailing Address - Zip Code:71465-4103
Mailing Address - Country:US
Mailing Address - Phone:318-381-3225
Mailing Address - Fax:
Practice Address - Street 1:820 DOWNS RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-8323
Practice Address - Country:US
Practice Address - Phone:318-387-1346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider