Provider Demographics
NPI:1275883050
Name:ABNER, BRIAN KEITH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KEITH
Last Name:ABNER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1150
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-5150
Mailing Address - Country:US
Mailing Address - Phone:606-627-1647
Mailing Address - Fax:
Practice Address - Street 1:215 NORTH ALLISON AVENUE
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906
Practice Address - Country:US
Practice Address - Phone:606-546-9287
Practice Address - Fax:606-546-0009
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1743363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYTC141OtherKENTUCKY BOARD OF MEDICAL LICENSURE IDENTIFICATION NUMBER