Provider Demographics
NPI:1134854755
Name:ABERNATHY, TRACI ANN
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:ANN
Last Name:ABERNATHY
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 1:1495 NATHANIAL DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-2160
Mailing Address - Country:US
Mailing Address - Phone:513-952-1639
Mailing Address - Fax:
Practice Address - Street 1:1495 NATHANIAL DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-2160
Practice Address - Country:US
Practice Address - Phone:513-952-1639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH347C00000X, 372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No347C00000XTransportation ServicesPrivate Vehicle