Provider Demographics
NPI:1912593302
Name:MABRY, JODI LEE (FNP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LEE
Last Name:MABRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:MAGGIE VALLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28751-0165
Mailing Address - Country:US
Mailing Address - Phone:803-367-2115
Mailing Address - Fax:
Practice Address - Street 1:9 OLD BURNSVILLE HILL RD STE 5
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-3140
Practice Address - Country:US
Practice Address - Phone:828-518-6996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013899363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily