Provider Demographics
NPI:1538353024
Name:ABERNATHY, JEANNIE ELLEN (LVN)
Entity type:Individual
Prefix:MS
First Name:JEANNIE
Middle Name:ELLEN
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8121
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79114-8121
Mailing Address - Country:US
Mailing Address - Phone:806-290-0444
Mailing Address - Fax:
Practice Address - Street 1:7209 ALPINE LN
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-6851
Practice Address - Country:US
Practice Address - Phone:806-290-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137207164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse