Provider Demographics
NPI:1013207836
Name:ABERNATHY, AVERY THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:AVERY
Middle Name:THOMAS
Last Name:ABERNATHY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6450 N CHATHAM AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2403
Mailing Address - Country:US
Mailing Address - Phone:816-741-5542
Mailing Address - Fax:816-746-4262
Practice Address - Street 1:6450 N CHATHAM AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2403
Practice Address - Country:US
Practice Address - Phone:816-741-5542
Practice Address - Fax:816-746-4262
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012038578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H69000006Medicare PIN