Provider Demographics
NPI:1083765663
Name:MCCOMBS, JAMIE RENEE' MYERS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:RENEE' MYERS
Last Name:MCCOMBS
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:
Practice Address - Street 1:410 2ND ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2115
Practice Address - Country:US
Practice Address - Phone:740-374-3622
Practice Address - Fax:740-374-4209
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002569RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant