Provider Demographics
NPI:1437754173
Name:BRELAND, ABIGAIL KRISTIN (PA-C)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:KRISTIN
Last Name:BRELAND
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 1:226 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-5329
Mailing Address - Country:US
Mailing Address - Phone:504-952-7225
Mailing Address - Fax:
Practice Address - Street 1:3439 PRYTANIA ST STE 501
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-7905
Practice Address - Country:US
Practice Address - Phone:504-754-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA324302363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant