Provider Demographics
NPI:1306827431
Name:ABERNATHY, BETTY ELLER (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:ELLER
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 WOODWIND DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-4532
Mailing Address - Country:US
Mailing Address - Phone:864-583-3913
Mailing Address - Fax:
Practice Address - Street 1:1241 BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2258
Practice Address - Country:US
Practice Address - Phone:864-591-0992
Practice Address - Fax:864-591-0776
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF2192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0528Medicaid
SCP224158101Medicare ID - Type UnspecifiedMEDICARE
SCNP0528Medicaid