Healthcare Provider Details

I. General information

NPI: 1558352682
Provider Name (Legal Business Name): ABBY L KOONS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W UNIVERSITY AVE
MUNCIE IN
47303-3428
US

IV. Provider business mailing address

221 N CELIA AVE ATTN: DEBERA BARKER
MUNCIE IN
47303-4609
US

V. Phone/Fax

Practice location:
  • Phone: 765-281-2030
  • Fax:
Mailing address:
  • Phone: 765-282-8905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001691A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: