Provider Demographics
NPI:1326439100
Name:CHILDRESS REYNA, ABIGAIL ANNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:ANNE
Last Name:CHILDRESS REYNA
Suffix:
Gender:F
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 1:5506 S JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9902
Mailing Address - Country:US
Mailing Address - Phone:956-661-0066
Mailing Address - Fax:
Practice Address - Street 1:5506 S JACKSON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9902
Practice Address - Country:US
Practice Address - Phone:956-661-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-14
Last Update Date:2015-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant