Provider Demographics
NPI:1922009539
Name:ABERNATHEY, DEANA LYNNE (CRNA)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:LYNNE
Last Name:ABERNATHEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10099 ROOKERY RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-7205
Mailing Address - Country:US
Mailing Address - Phone:850-497-8123
Mailing Address - Fax:850-497-8156
Practice Address - Street 1:1015 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6748
Practice Address - Country:US
Practice Address - Phone:334-418-4105
Practice Address - Fax:334-418-3546
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-098515367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86765UOtherBCBSTX
TX8J0799Medicare PIN