Provider Demographics
NPI:1073557773
Name:MABERY, JEWELL S (ANP)
Entity Type:Individual
Prefix:
First Name:JEWELL
Middle Name:S
Last Name:MABERY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:JEWELL
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:616 WESTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-3622
Mailing Address - Country:US
Mailing Address - Phone:828-465-2719
Mailing Address - Fax:
Practice Address - Street 1:3125 POPLARWOOD CT
Practice Address - Street 2:ASPEN BLDG, SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1084
Practice Address - Country:US
Practice Address - Phone:800-632-6074
Practice Address - Fax:866-341-7509
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900215363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP04046Medicare UPIN
NC2599205CMedicare ID - Type UnspecifiedPROVIDER # W PARADIGM