Provider Demographics
NPI:1174205678
Name:MABE, JAMIE ALEXA
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:ALEXA
Last Name:MABE
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 1:1454 ZION CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:VA
Mailing Address - Zip Code:24323-3109
Mailing Address - Country:US
Mailing Address - Phone:276-782-0369
Mailing Address - Fax:
Practice Address - Street 1:812 W STUART DR
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2605
Practice Address - Country:US
Practice Address - Phone:276-601-2841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program