Provider Demographics
NPI:1649655317
Name:CALLAHAN, ABIGAIL BROOKS (AC-PNP)
Entity type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:BROOKS
Last Name:CALLAHAN
Suffix:
Gender:
Credentials:AC-PNP
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:CHRISTINE
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:110 N CLEARWATER DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-6718
Mailing Address - Country:US
Mailing Address - Phone:619-723-3895
Mailing Address - Fax:
Practice Address - Street 1:9525 GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4116
Practice Address - Country:US
Practice Address - Phone:281-409-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95001371363L00000X
TX1146506363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner