Provider Demographics
NPI:1053813709
Name:ROSE, JAMIE ALLEY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ALLEY
Last Name:ROSE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 OLD WILDERNESS RD
Mailing Address - Street 2:
Mailing Address - City:SALTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24370-4229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:933 OLD WILDERNESS RD
Practice Address - Street 2:
Practice Address - City:SALTVILLE
Practice Address - State:VA
Practice Address - Zip Code:24370-4229
Practice Address - Country:US
Practice Address - Phone:276-782-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174594363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily