Active NPI
Abigail Mark-Ekpendu, PA
- Medical Physician Assistant
- Riverbank, CA
National Provider Identifier
1629473723
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 52004
- Practice address
- 4150 Patterson Road
Riverbank, CA 95367 - Phone
- (209) 863-3900
- Fax
- (209) 863-3999
- NPI assigned
- Oct 31, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 52004 | CA | Primary |
Addresses
Primary practice location
4150 Patterson Road
Riverbank, CA 95367
Mailing address
1218 Prasher Avenue
Stockton, CA 95209
Phone (209) 330-1034
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1414713600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414713600000",
"number": "1629473723",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1218 PRASHER AVENUE",
"city": "STOCKTON",
"state": "CA",
"postal_code": "95209",
"telephone_number": "209-330-1034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4150 PATTERSON ROAD",
"city": "RIVERBANK",
"state": "CA",
"postal_code": "95367",
"telephone_number": "209-863-3900",
"fax_number": "209-863-3999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARK-EKPENDU",
"first_name": "ABIGAIL",
"name_prefix": "Ms.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-10-31",
"last_updated": "2014-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CA",
"license": "52004",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverbank, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.