Provider Demographics
NPI:1578161865
Name:JOHNSON, ABIGAIL LEIGH (APRN, CNP)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:LEIGH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:HARDESTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1420 W PIONEER PKWY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1941
Mailing Address - Country:US
Mailing Address - Phone:309-308-9540
Mailing Address - Fax:
Practice Address - Street 1:3422A COURT ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6235
Practice Address - Country:US
Practice Address - Phone:309-477-6000
Practice Address - Fax:309-477-6001
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily