Provider Demographics
NPI:1376991091
Name:MARTIN, ABBIE ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:ELIZABETH
Last Name:MARTIN
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 1:14253 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-3367
Mailing Address - Country:US
Mailing Address - Phone:913-218-0162
Mailing Address - Fax:913-301-5506
Practice Address - Street 1:455 NW MURRAY RD
Practice Address - Street 2:
Practice Address - City:LEE'S SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081
Practice Address - Country:US
Practice Address - Phone:913-218-0162
Practice Address - Fax:913-301-5506
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77259363LF0000X
MO2022031560363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily