Abby Provencal, APRN
Individual provider Active NPI Family Nurse Practitioner · Cosby, TN
NPI 1881267441 · NPPES record last updated Jul 21, 2021
Key facts
- NPI
- 1881267441
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 29912 (TN)
- Practice address
- 842 Yellow Springs Rd
Cosby, TN 37722-3443 - Phone
- (423) 721-2929
- NPI assigned
- Jul 21, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29912 | TN | MD | Family Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 29912 | TN | Yes |
Addresses
Primary practice location
842 Yellow Springs Rd
Cosby, TN 37722-3443
Mailing address
842 Yellow Springs Rd
Cosby, TN 37722-3443
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 29912 | Other | TN | APRN LICENSE NUMBER |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | abby.provencal@waldenu.edu | ||
| CONNECT URL | abby.provencal@waldenu.edu |
Other providers in Cosby, TN
All providers in Cosby, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.