Healthcare Provider Details

I. General information

NPI: 1982147765
Provider Name (Legal Business Name): TORI LAYNE ABERNATHY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TORI EUBANKS

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 SE 14TH ST
BENTONVILLE AR
72712-4900
US

IV. Provider business mailing address

3101 SE 14TH ST
BENTONVILLE AR
72712-4900
US

V. Phone/Fax

Practice location:
  • Phone: 479-986-6090
  • Fax: 479-986-6250
Mailing address:
  • Phone: 479-986-6090
  • Fax: 479-986-6250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5009174
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR096201
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: