Provider Demographics
NPI:1124574157
Name:ABRAHAM, BLEXY JIGI (APRN)
Entity Type:Individual
Prefix:
First Name:BLEXY
Middle Name:JIGI
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BLEXY
Other - Middle Name:SUSAN
Other - Last Name:JOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2121 S BUCKNER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-8602
Mailing Address - Country:US
Mailing Address - Phone:214-381-1187
Mailing Address - Fax:214-381-7213
Practice Address - Street 1:2121 S BUCKNER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-8602
Practice Address - Country:US
Practice Address - Phone:214-381-1187
Practice Address - Fax:214-381-7213
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131743363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX384319501Medicaid