Provider Demographics
NPI:1821230939
Name:MCREYNOLDS, ABIGAIL NANCE (PA-C)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:NANCE
Last Name:MCREYNOLDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 WILLIAMS DR
Mailing Address - Street 2:SUITE 177
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2764
Mailing Address - Country:US
Mailing Address - Phone:512-868-3376
Mailing Address - Fax:512-869-5868
Practice Address - Street 1:3010 WILLIAMS DR
Practice Address - Street 2:SUITE 177
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2764
Practice Address - Country:US
Practice Address - Phone:512-868-3376
Practice Address - Fax:512-869-5868
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06083363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX289385101Medicaid
TX289385101Medicaid