Provider Demographics
NPI:1316564115
Name:PELTON, ABBEY (NP)
Entity Type:Individual
Prefix:
First Name:ABBEY
Middle Name:
Last Name:PELTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9060 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:HALLIDAY
Mailing Address - State:ND
Mailing Address - Zip Code:58636-9211
Mailing Address - Country:US
Mailing Address - Phone:701-230-1713
Mailing Address - Fax:
Practice Address - Street 1:1312 HIGHWAY 49 N
Practice Address - Street 2:
Practice Address - City:BEULAH
Practice Address - State:ND
Practice Address - Zip Code:58523-6038
Practice Address - Country:US
Practice Address - Phone:701-873-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR39027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily