Provider Demographics
NPI:1437882370
Name:PETERMANN, ABIGAIL KELLY
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:KELLY
Last Name:PETERMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 SE WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-0601
Mailing Address - Country:US
Mailing Address - Phone:918-766-4721
Mailing Address - Fax:
Practice Address - Street 1:5210 SE WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-0601
Practice Address - Country:US
Practice Address - Phone:918-766-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherI DON'T HAVE ANY