Provider Demographics
NPI:1174869986
Name:FABER, JAMIE MARIE (PA)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
Last Name:FABER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:MARIE
Other - Last Name:ECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1113 N CANTERBURY CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2741
Mailing Address - Country:US
Mailing Address - Phone:316-322-5129
Mailing Address - Fax:
Practice Address - Street 1:3450 W CAMP WISDOM RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2515
Practice Address - Country:US
Practice Address - Phone:214-214-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-26
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08192363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX316587001Medicaid
TX897N41OtherBCBS
TX263888YKQHMedicare PIN