Provider Demographics
NPI:1952495525
Name:WADE, JODIE BEMBRY (NP)
Entity Type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:BEMBRY
Last Name:WADE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:186 MEDICAL PARK LOOP
Mailing Address - Street 2:STE 503
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5275
Mailing Address - Country:US
Mailing Address - Phone:828-586-7994
Mailing Address - Fax:828-586-7340
Practice Address - Street 1:186 MEDICAL PARK LOOP
Practice Address - Street 2:SUITE 503
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5222
Practice Address - Country:US
Practice Address - Phone:828-586-7994
Practice Address - Fax:828-586-7940
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201010363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP63255Medicare UPIN