Provider Demographics
NPI:1679023071
Name:PEAVY, JAMIE HOWARD (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:HOWARD
Last Name:PEAVY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12761 HIGHWAY 22 EAST
Mailing Address - Street 2:
Mailing Address - City:NEW SITE
Mailing Address - State:AL
Mailing Address - Zip Code:36256-0939
Mailing Address - Country:US
Mailing Address - Phone:256-392-3300
Mailing Address - Fax:
Practice Address - Street 1:3316 HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3369
Practice Address - Country:US
Practice Address - Phone:256-329-7308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-102855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-102855OtherLICENCE NUMBER