Provider Demographics
NPI:1700417821
Name:DAVIS, ABIGAIL U
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:U
Last Name:DAVIS
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 1:5113 GLEN CANYON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-4104
Mailing Address - Country:US
Mailing Address - Phone:817-879-9714
Mailing Address - Fax:
Practice Address - Street 1:5113 GLEN CANYON RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-4104
Practice Address - Country:US
Practice Address - Phone:817-879-9714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program