Provider Demographics
NPI:1609068824
Name:CLODFELTER, JAIMIE ANN (DO)
Entity type:Individual
Prefix:
First Name:JAIMIE
Middle Name:ANN
Last Name:CLODFELTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 AVENUE B
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4617
Mailing Address - Country:US
Mailing Address - Phone:308-630-2992
Mailing Address - Fax:308-630-2995
Practice Address - Street 1:3911 AVENUE B
Practice Address - Street 2:SUITE 2300
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4617
Practice Address - Country:US
Practice Address - Phone:308-630-2992
Practice Address - Fax:308-630-2995
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-11
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADO.0001452081P2900X
NE8572081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine