Healthcare Provider Details

I. General information

NPI: 1649942129
Provider Name (Legal Business Name): ABIGAIL OKANTEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2021
Last Update Date: 10/02/2021
Certification Date: 10/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 EMERALD SPRING DR
KNIGHTDALE NC
27545-7553
US

IV. Provider business mailing address

5440 EMERALD SPRING DR
KNIGHTDALE NC
27545-7553
US

V. Phone/Fax

Practice location:
  • Phone: 919-441-1287
  • Fax:
Mailing address:
  • Phone: 919-441-1287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07211180
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: