Provider Demographics
NPI:1669364402
Name:FARISH, JAMMIE LYNN
Entity type:Individual
Prefix:
First Name:JAMMIE
Middle Name:LYNN
Last Name:FARISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMMIE
Other - Middle Name:
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12522 W REGAL DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-5165
Mailing Address - Country:US
Mailing Address - Phone:503-730-9943
Mailing Address - Fax:
Practice Address - Street 1:530 DIVISADERO ST STE 108
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2213
Practice Address - Country:US
Practice Address - Phone:415-349-3901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist