Provider Demographics
NPI:1023779964
Name:CLEGG, JAMIE (RRT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:CLEGG
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:HUNT, GARCIA, BYRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:959 TAMBORA ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-4178
Mailing Address - Country:US
Mailing Address - Phone:505-239-3644
Mailing Address - Fax:
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2719
Practice Address - Country:US
Practice Address - Phone:505-239-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2824227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered