Provider Demographics
NPI:1457345779
Name:ABERNATHY, MARY DARLENE (A P N)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:DARLENE
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:A P N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MERCY LN
Mailing Address - Street 2:SUITE 502
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6442
Mailing Address - Country:US
Mailing Address - Phone:501-321-3573
Mailing Address - Fax:
Practice Address - Street 1:1 MERCY LN
Practice Address - Street 2:SUITE 502
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6442
Practice Address - Country:US
Practice Address - Phone:501-321-3573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01622363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
5Y1357470OtherMEDICARE PTAN
AR164430758Medicaid
P00418835OtherRAILROAD MEDICARE
5Y1357470OtherMEDICARE PTAN
AR164430758Medicaid