Provider Demographics
NPI:1164081105
Name:KENT, ABIGAIL GRACE
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:GRACE
Last Name:KENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25395 HANCOCK AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9054
Mailing Address - Country:US
Mailing Address - Phone:512-290-7089
Mailing Address - Fax:
Practice Address - Street 1:25395 HANCOCK AVE STE 200
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9054
Practice Address - Country:US
Practice Address - Phone:512-290-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant