Provider Demographics
NPI:1215699012
Name:LUTHY, ABIGAIL LYNNE (AGACNP, RN)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LYNNE
Last Name:LUTHY
Suffix:
Gender:F
Credentials:AGACNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W GARDNER ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-5019
Mailing Address - Country:US
Mailing Address - Phone:281-386-7284
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN ST STE 2206
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2726
Practice Address - Country:US
Practice Address - Phone:713-790-4615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056600363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care