Jamie Chapman Clark, DDS
Individual provider Active NPI Dentist · Lexington, VA
NPI 1629319694 · NPPES record last updated Aug 28, 2019
Key facts
- NPI
- 1629319694
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 0401414729 (VA)
- Practice address
- 25 Northridge LN
Lexington, VA 24450-3399 - Phone
- (530) 464-8700
- NPI assigned
- Mar 15, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160317002020 | VA | Order and Referring Only - Dentist |
1153628151 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DR60360697 | WA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rockbridge Area Free Clinic | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DR60360697 | WA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 0401414729 | VA | Yes |
Addresses
Primary practice location
25 Northridge LN
Lexington, VA 24450-3399
Mailing address
25 Northridge LN
Lexington, VA 24450-3399
Phone (703) 470-6610
Other providers in Lexington, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.