Provider Demographics
NPI:1669015863
Name:ABBEY, BYRON KEITH SR
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:KEITH
Last Name:ABBEY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 SAINT REGIS
Mailing Address - Street 2:
Mailing Address - City:WEST HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72390-2036
Mailing Address - Country:US
Mailing Address - Phone:901-299-2784
Mailing Address - Fax:870-912-0018
Practice Address - Street 1:704 SAINT REGIS
Practice Address - Street 2:
Practice Address - City:WEST HELENA
Practice Address - State:AR
Practice Address - Zip Code:72390-2036
Practice Address - Country:US
Practice Address - Phone:901-299-2784
Practice Address - Fax:870-912-0018
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)