Provider Demographics
NPI:1942781117
Name:MOTHERSHED, JAIME
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:MOTHERSHED
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 1:216 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-4846
Mailing Address - Country:US
Mailing Address - Phone:806-274-1819
Mailing Address - Fax:
Practice Address - Street 1:1303 82ND ST STE 150
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2766
Practice Address - Country:US
Practice Address - Phone:806-503-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320686164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse