Provider Demographics
NPI:1982147765
Name:ABERNATHY, TORI LAYNE (FNP)
Entity Type:Individual
Prefix:
First Name:TORI
Middle Name:LAYNE
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TORI
Other - Middle Name:
Other - Last Name:EUBANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3101 SE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4900
Mailing Address - Country:US
Mailing Address - Phone:479-986-6090
Mailing Address - Fax:479-986-6250
Practice Address - Street 1:3101 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4900
Practice Address - Country:US
Practice Address - Phone:479-986-6090
Practice Address - Fax:479-986-6250
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009174363LF0000X
ARR096201363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program