Provider Demographics
NPI:1144661133
Name:ABBEY, PRINCESS P (PA)
Entity type:Individual
Prefix:
First Name:PRINCESS
Middle Name:P
Last Name:ABBEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PRINCESS
Other - Middle Name:
Other - Last Name:POKU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:14325 BALLANTYNE LAKE RD APT 1113
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3369
Mailing Address - Country:US
Mailing Address - Phone:646-320-9973
Mailing Address - Fax:
Practice Address - Street 1:14325 BALLANTYNE LAKE RD APT 1113
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3369
Practice Address - Country:US
Practice Address - Phone:646-320-9973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016675363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant