Provider Demographics
NPI:1982407664
Name:JAMISON, STORMY (BSN RN)
Entity type:Individual
Prefix:
First Name:STORMY
Middle Name:
Last Name:JAMISON
Suffix:
Gender:
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 HARROLD ST APT 1207
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2652
Mailing Address - Country:US
Mailing Address - Phone:949-463-5855
Mailing Address - Fax:
Practice Address - Street 1:416 HARROLD ST APT 1207
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2652
Practice Address - Country:US
Practice Address - Phone:949-463-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK221827163W00000X
TX1192789163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse