Provider Demographics
NPI:1952811655
Name:JORGENSON, ABIGAYLE (PA-C)
Entity Type:Individual
Prefix:
First Name:ABIGAYLE
Middle Name:
Last Name:JORGENSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST STE 1842
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2715
Mailing Address - Country:US
Mailing Address - Phone:713-790-2089
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN ST STE 1842
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-790-2089
Practice Address - Fax:713-794-0576
Is Sole Proprietor?:No
Enumeration Date:2017-10-07
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
TXPA11548363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX378717801Medicaid