Provider Demographics
NPI: | 1437158664 |
---|---|
Name: | ABERNATHY-CARVER, KATHERINE JEAN (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | KATHERINE |
Middle Name: | JEAN |
Last Name: | ABERNATHY-CARVER |
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: | 2509 VIRGINIA ST NE |
Mailing Address - Street 2: | STE B |
Mailing Address - City: | ALBUQUERQUE |
Mailing Address - State: | NM |
Mailing Address - Zip Code: | 87110-4694 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 505-294-1471 |
Mailing Address - Fax: | 505-293-7148 |
Practice Address - Street 1: | 2509 VIRGINIA ST NE |
Practice Address - Street 2: | STE B |
Practice Address - City: | ALBUQUERQUE |
Practice Address - State: | NM |
Practice Address - Zip Code: | 87110-4694 |
Practice Address - Country: | US |
Practice Address - Phone: | 505-294-1471 |
Practice Address - Fax: | 505-293-7148 |
Is Sole Proprietor?: | Not Answered |
Enumeration Date: | 2005-07-19 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NM | 941 | 207K00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NM | 15349 | Medicaid | |
NM | NM003311 | Other | BLUE CROSS BLUE SHIELD |
NM | 10097 | Other | PRESBYTERIAN HEALTH |
NM | 10097 | Other | PRESBYTERIAN HEALTH |