Provider Demographics
NPI:1851872501
Name:ABERNATHY, CARRLEIGH PAIGE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CARRLEIGH
Middle Name:PAIGE
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2449 INDIAN HEAD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-2069
Mailing Address - Country:US
Mailing Address - Phone:205-601-4742
Mailing Address - Fax:
Practice Address - Street 1:7232 NORTH FWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-2481
Practice Address - Country:US
Practice Address - Phone:817-232-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC308018163W00000X
TX966908163W00000X
NC5011022363LF0000X
TXAP141671363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse