Provider Demographics
NPI:1063715936
Name:SHOWALTER, JAMIE ROBERTS (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:ROBERTS
Last Name:SHOWALTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:ROBERTS
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:196 FOOR RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:PA
Mailing Address - Zip Code:16650-7553
Mailing Address - Country:US
Mailing Address - Phone:814-248-0323
Mailing Address - Fax:
Practice Address - Street 1:608 E PITT ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-9723
Practice Address - Country:US
Practice Address - Phone:814-624-3121
Practice Address - Fax:814-266-2880
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052567363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical