Provider Demographics
NPI:1821413857
Name:ABRAHAM, JOHNY (FNP)
Entity Type:Individual
Prefix:MR
First Name:JOHNY
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-2215
Mailing Address - Country:US
Mailing Address - Phone:979-942-9084
Mailing Address - Fax:718-640-2713
Practice Address - Street 1:1249 DEER RIDGE DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5203
Practice Address - Country:US
Practice Address - Phone:281-332-8163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP114875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily