Provider Demographics
NPI:1710353487
Name:MARTIN, ABIGAIL
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:MARTIN
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:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:115 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2105
Practice Address - Country:US
Practice Address - Phone:903-885-7671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03179363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8536NROtherBCBS
TX8821NSOtherBCBS
TXP01536083OtherRAIL ROAD
TX75-0818167-048OtherTRICARE
TX75-2616977-001OtherTRICARE
TX8422NSOtherBCBS
TX8535NROtherBCBS
TXP01536084OtherRAIL ROAD
TX349884201Medicaid
TX75-0818167-044OtherTRICARE
TX75-2616977-028OtherTRICARE
TX3498842022Medicaid
TX75-1976930-005OtherTRICARE
TXP01536090OtherRAIL ROAD
TX75-0818167-015OtherTRICARE
TX75-0818167-022OtherTRICARE
TX75-2616977-002OtherTRICARE
TXP01536084OtherRAIL ROAD
TX3498842022Medicaid
TX438745YS6PMedicare PIN
TX438745YNSXMedicare PIN