Healthcare Provider Details

I. General information

NPI: 1598828543
Provider Name (Legal Business Name): JAMES AUSTIN MABE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3699 ALEXANDRIA PIKE
COLD SPRING KY
41076-1789
US

IV. Provider business mailing address

1271 VIOLA LN
ERLANGER KY
41018-3821
US

V. Phone/Fax

Practice location:
  • Phone: 859-442-8444
  • Fax:
Mailing address:
  • Phone: 859-250-6771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA765
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50-001905
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: