Healthcare Provider Details

I. General information

NPI: 1043023948
Provider Name (Legal Business Name): PEYTON MACKENZIE MABINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 VICAR PL
DANVILLE VA
24540-1241
US

IV. Provider business mailing address

1189 DEER RUN RD
HALIFAX VA
24558-2327
US

V. Phone/Fax

Practice location:
  • Phone: 434-272-8372
  • Fax:
Mailing address:
  • Phone: 434-222-9855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: