Provider Demographics
NPI:1013598168
Name:ABERNATHY, WILLIAM MARCUS (MA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARCUS
Last Name:ABERNATHY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7519 E 97TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6408
Mailing Address - Country:US
Mailing Address - Phone:480-749-4441
Mailing Address - Fax:
Practice Address - Street 1:4934 E 73RD ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7007
Practice Address - Country:US
Practice Address - Phone:918-913-0430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician