Provider Demographics
NPI:1316697352
Name:ABRAHAM, USHA THOPPIL (AGACNP)
Entity type:Individual
Prefix:
First Name:USHA
Middle Name:THOPPIL
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:USHA
Other - Middle Name:THOPPIL
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:ST. JOHN'S MEDICAL CENTER
Mailing Address - Street 2:2100 WHEELING AVE
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104
Mailing Address - Country:US
Mailing Address - Phone:918-744-2345
Mailing Address - Fax:
Practice Address - Street 1:8500 TAD PARK CV
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3533
Practice Address - Country:US
Practice Address - Phone:512-680-9143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1071733363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology