Provider Demographics
NPI:1205480787
Name:DEAVER, JEANIE K
Entity type:Individual
Prefix:
First Name:JEANIE
Middle Name:K
Last Name:DEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2084
Mailing Address - Street 2:
Mailing Address - City:MAGGIE VALLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28751-2084
Mailing Address - Country:US
Mailing Address - Phone:828-335-2877
Mailing Address - Fax:
Practice Address - Street 1:48 COMFORT LN
Practice Address - Street 2:
Practice Address - City:MAGGIE VALLEY
Practice Address - State:NC
Practice Address - Zip Code:28751-5501
Practice Address - Country:US
Practice Address - Phone:828-335-2877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider