Provider Demographics
NPI:1285381053
Name:NOVAK, ABBY NICOLE (NP)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:NICOLE
Last Name:NOVAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11961 NEWTON COUNTY MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39325-8930
Mailing Address - Country:US
Mailing Address - Phone:601-513-2609
Mailing Address - Fax:
Practice Address - Street 1:296 EASTSIDE DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345-8036
Practice Address - Country:US
Practice Address - Phone:601-228-8985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily