Provider Demographics
NPI:1558601252
Name:ABERNATHY, MARY MARTHA
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:MARTHA
Last Name:ABERNATHY
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 1:343 S KIRKWOOD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4015
Mailing Address - Country:US
Mailing Address - Phone:314-206-3400
Mailing Address - Fax:
Practice Address - Street 1:343 S KIRKWOOD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-4015
Practice Address - Country:US
Practice Address - Phone:314-206-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator