Provider Demographics
NPI:1790774628
Name:MABE, LAYLA MYERS (ANP)
Entity Type:Individual
Prefix:MRS
First Name:LAYLA
Middle Name:MYERS
Last Name:MABE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8749
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:910-235-3447
Practice Address - Street 1:15 REGIONAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8850
Practice Address - Country:US
Practice Address - Phone:910-255-4400
Practice Address - Fax:910-235-3447
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900378363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004470Medicaid
NCP00439348OtherRR MEDICARE
NCP01173872OtherR/R MEDICARE EFFECTIVE 2/25/2013
NC89014R7OtherCAROLINA ACCESS
SCNP0937Medicaid
NCNCB705AOtherPALMETTO GBA MEDICARE EFFECTIVE 2/25/2013
NCNCB705AOtherPALMETTO GBA MEDICARE EFFECTIVE 2/25/2013
NCP89109Medicare UPIN