Active NPI
Jacie Homm
- Dental Hygienist
- La Junta, CO
National Provider Identifier
1710142112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 905307
- Practice address
- 2322 San Juan Ave
La Junta, CO 81050-3341 - Phone
- (719) 383-3939
- NPI assigned
- Jul 24, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 905307 | CO | Primary |
Addresses
Primary practice location
2322 San Juan Ave
La Junta, CO 81050-3341
Mailing address
2322 San Juan Ave
La Junta, CO 81050-3341
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 58300783 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 905307 | CO | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216857600000",
"number": "1710142112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2322 SAN JUAN AVE",
"city": "LA JUNTA",
"state": "CO",
"postal_code": "810503341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2322 SAN JUAN AVE",
"city": "LA JUNTA",
"state": "CO",
"postal_code": "810503341",
"telephone_number": "719-383-3939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOMM",
"first_name": "JACIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-24",
"last_updated": "2008-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "CO",
"license": "905307",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "58300783",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in La Junta, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.