Provider Demographics
NPI:1598366296
Name:MEREDITH, ABIGAIL ELLERY (NP)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ELLERY
Last Name:MEREDITH
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 1:1942 EVERGLADE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-2854
Mailing Address - Country:US
Mailing Address - Phone:559-451-1323
Mailing Address - Fax:
Practice Address - Street 1:3121 E OLIVE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-1030
Practice Address - Country:US
Practice Address - Phone:559-412-4927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily