Basic Information
| Provider Information | |||||||||
| NPI: | 1790774628 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MABE | ||||||||
| FirstName: | LAYLA | ||||||||
| MiddleName: | MYERS | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 PAGE RD | ||||||||
| Address2: | |||||||||
| City: | PINEHURST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283748749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102955511 | ||||||||
| FaxNumber: | 9102353447 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 REGIONAL DR | ||||||||
| Address2: | |||||||||
| City: | PINEHURST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283748850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102554400 | ||||||||
| FaxNumber: | 9102353447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2005 | ||||||||
| LastUpdateDate: | 02/25/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 900378 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2200X | 900378 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 7004470 | 05 | NC | MEDICAID | P00439348 | 01 | NC | RR MEDICARE | OTHER | P01173872 | 01 | NC | R/R MEDICARE EFFECTIVE 2/25/2013 | OTHER | 89014R7 | 01 | NC | CAROLINA ACCESS | OTHER | NP0937 | 05 | SC | MEDICAID | NCB705A | 01 | NC | PALMETTO GBA MEDICARE EFFECTIVE 2/25/2013 | OTHER |