Provider Demographics
NPI:1285668921
Name:MISHRA, ABHA (MD)
Entity Type:Individual
Prefix:DR
First Name:ABHA
Middle Name:
Last Name:MISHRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 E SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-4620
Mailing Address - Country:US
Mailing Address - Phone:228-452-6121
Mailing Address - Fax:228-452-6121
Practice Address - Street 1:1340 BROAD AVE STE 440
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2460
Practice Address - Country:US
Practice Address - Phone:228-867-4855
Practice Address - Fax:228-867-4870
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2021-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0359782084N0400X
VA01012393952084N0400X
MS197972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00051815Medicaid
MS302I139117Medicare PIN