Provider Demographics
NPI:1093071011
Name:BIVANS, ABIGAIL CLAUDIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:CLAUDIA
Last Name:BIVANS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ABIGAIL
Other - Middle Name:CLAUDIA
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27938-9424
Mailing Address - Country:US
Mailing Address - Phone:252-357-1226
Mailing Address - Fax:252-357-1236
Practice Address - Street 1:501 MAIN ST
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27938-9424
Practice Address - Country:US
Practice Address - Phone:252-357-1226
Practice Address - Fax:252-357-1236
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001003301363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant