Provider Demographics
NPI:1083940712
Name:ABERNATHY, LATOYA DENISE (PA-C)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:DENISE
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 KINGSLEY DR STE 610
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8508
Mailing Address - Country:US
Mailing Address - Phone:832-987-3352
Mailing Address - Fax:832-281-0853
Practice Address - Street 1:3129 KINGSLEY DR STE 610
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8508
Practice Address - Country:US
Practice Address - Phone:832-987-3352
Practice Address - Fax:832-281-0853
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20638363AM0700X
TXPA07046363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical