Provider Demographics
NPI:1073179875
Name:ABERNATHY, TRYNA LATETHIA
Entity Type:Individual
Prefix:
First Name:TRYNA
Middle Name:LATETHIA
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 E DESERT INN RD UNIT 26
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-2760
Mailing Address - Country:US
Mailing Address - Phone:702-980-8716
Mailing Address - Fax:
Practice Address - Street 1:1711 E DESERT INN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3201
Practice Address - Country:US
Practice Address - Phone:702-839-1088
Practice Address - Fax:702-650-2800
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant