Provider Demographics
NPI:1558561431
Name:MAYO, JAYME (PA-C)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:
Last Name:MAYO
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 1:612 GARLAND ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4418
Mailing Address - Country:US
Mailing Address - Phone:501-505-5165
Mailing Address - Fax:501-505-5265
Practice Address - Street 1:612 GARLAND ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4418
Practice Address - Country:US
Practice Address - Phone:501-505-5165
Practice Address - Fax:501-505-5265
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-302363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical