Provider Demographics
NPI:1275907354
Name:DICHIARA, ABBEY JOHNSON (NP)
Entity Type:Individual
Prefix:
First Name:ABBEY
Middle Name:JOHNSON
Last Name:DICHIARA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ABBEY
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2323 5TH ST N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2213
Mailing Address - Country:US
Mailing Address - Phone:662-368-1169
Mailing Address - Fax:662-570-1492
Practice Address - Street 1:2323 5TH ST N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2213
Practice Address - Country:US
Practice Address - Phone:662-368-1169
Practice Address - Fax:662-570-1492
Is Sole Proprietor?:No
Enumeration Date:2015-11-30
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR888625363L00000X
TN20721363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN20721OtherAPN -TN LICENSE