Provider Demographics
NPI:1992304885
Name:KALEM, ABBIE BRIELLE (FNP)
Entity type:Individual
Prefix:
First Name:ABBIE
Middle Name:BRIELLE
Last Name:KALEM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ABBIE
Other - Middle Name:BRIELLE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:129 CENTER ST STE B
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:39218-4800
Mailing Address - Country:US
Mailing Address - Phone:769-233-7141
Mailing Address - Fax:769-233-7726
Practice Address - Street 1:129 CENTER ST STE B
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218-4800
Practice Address - Country:US
Practice Address - Phone:769-233-7141
Practice Address - Fax:769-233-7726
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904228363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily