Individual provider Active NPI

Abigail Peterson, PA-C

  • Physician Assistant
  • Montgomery, AL
National Provider Identifier
1265312300
Registry record updated Aug 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA61574941 Issued in WA
Practice address
5345 Atlanta Hwy
Montgomery, AL 36109-3323
Phone
(334) 386-7300
NPI assigned
Sep 8, 2025
Sex
Unspecified or another gender identity
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA61574941 WA Primary

Addresses

Primary practice location

5345 Atlanta Hwy
Montgomery, AL 36109-3323

Mailing address

1515 E Columbia St
Othello, WA 99344-1846
Phone (509) 488-5256

Other practice location 1

1051 S Columbia Ave
Connell, WA 99326-8711
Phone (509) 488-5256 ext. 8512

Other practice location 2

1515 E Columbia St
Othello, WA 99344-1846
Phone (509) 488-5256 ext. 8512

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1757289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785974400000",
    "number": "1265312300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 E COLUMBIA ST",
            "city": "OTHELLO",
            "state": "WA",
            "postal_code": "993441846",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5345 ATLANTA HWY",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361093323",
            "telephone_number": "334-386-7300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1051 S Columbia Ave",
            "address_purpose": "LOCATION",
            "city": "Connell",
            "state": "WA",
            "postal_code": "993268711",
            "country_code": "US",
            "telephone_number": "509-488-5256 x8512",
            "fax_number": "509-488-9939",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1515 E Columbia St",
            "address_purpose": "LOCATION",
            "city": "Othello",
            "state": "WA",
            "postal_code": "993441846",
            "country_code": "US",
            "telephone_number": "509-488-5256 x8512",
            "fax_number": "509-488-9939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ABIGAIL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "X",
        "enumeration_date": "2025-09-08",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61574941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, AL

Sources for this page

Verify at the official NPI Registry.