Provider Demographics
NPI:1154549566
Name:IVEY, ABENA TALIBAH (FNP)
Entity type:Individual
Prefix:
First Name:ABENA
Middle Name:TALIBAH
Last Name:IVEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 E PARHAM RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2932
Mailing Address - Country:US
Mailing Address - Phone:804-262-2333
Mailing Address - Fax:804-262-0848
Practice Address - Street 1:2600 E PARHAM RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2932
Practice Address - Country:US
Practice Address - Phone:804-262-2333
Practice Address - Fax:804-262-0848
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024116568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC07050OtherGROUP PTAN
VAC06778OtherGROUP PTAN