Healthcare Provider Details

I. General information

NPI: 1952296618
Provider Name (Legal Business Name): ABIGAIL NEARY FNP - C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 LAKELAND DR
JACKSON MS
39216-4606
US

IV. Provider business mailing address

122 SEVILLE WAY
MADISON MS
39110-8170
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-2000
  • Fax:
Mailing address:
  • Phone: 601-209-7039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907496
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: