MEDICARE: MR. JAMES DARRELL ABBOTT ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	AP60252663	WA

General Provider Information

NPI Number	:	1457636888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES DARRELL ABBOTT ARNP

Provider Business Mailing Address
First Line	:	PSC 557 BOX 1151
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96379-1100
Country	:	US
Telephone Number	:	08064954367
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 557 BOX 1151
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96379-1100
Country	:	US
Telephone Number	:	08064954367
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	10/17/2011

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