Healthcare Provider Details

I. General information

NPI: 1881521110
Provider Name (Legal Business Name): AMY MARIE ABERNATHY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464099 STATE ROAD 200 STE 2
YULEE FL
32097-6460
US

IV. Provider business mailing address

103 PARADISE CT
KINGSLAND GA
31548-6908
US

V. Phone/Fax

Practice location:
  • Phone: 904-875-4461
  • Fax:
Mailing address:
  • Phone: 404-216-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: