Provider Demographics
NPI:1982350237
Name:COASTAL PRIMARY CARE AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:COASTAL PRIMARY CARE AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MABE
Authorized Official - Suffix:
Authorized Official - Credentials:AGNP-C
Authorized Official - Phone:336-613-4862
Mailing Address - Street 1:7183 BEACH DR SW # 1
Mailing Address - Street 2:
Mailing Address - City:OCEAN ISLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28469-5634
Mailing Address - Country:US
Mailing Address - Phone:910-795-1700
Mailing Address - Fax:910-661-0683
Practice Address - Street 1:7183 BEACH DR SW # 1
Practice Address - Street 2:
Practice Address - City:OCEAN ISLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28469-5634
Practice Address - Country:US
Practice Address - Phone:910-795-1700
Practice Address - Fax:910-661-0683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty