Provider Demographics
NPI:1487912283
Name:FAIRGRIEVE, JAMIE PATTERSON (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:PATTERSON
Last Name:FAIRGRIEVE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 CENTREVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-3289
Mailing Address - Country:US
Mailing Address - Phone:703-481-8600
Mailing Address - Fax:
Practice Address - Street 1:3914 CENTREVILLE RD
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-3289
Practice Address - Country:US
Practice Address - Phone:703-481-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003767363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant