Provider Demographics
NPI:1023882966
Name:MARTIN, JAMIE R
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:R
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7365 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:WV
Mailing Address - Zip Code:26180-3615
Mailing Address - Country:US
Mailing Address - Phone:304-639-1514
Mailing Address - Fax:
Practice Address - Street 1:807 FARSON ST STE 101
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1000
Practice Address - Country:US
Practice Address - Phone:740-423-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0035399363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health