Healthcare Provider Details

I. General information

NPI: 1992639694
Provider Name (Legal Business Name): JESSE A ABERNATHY CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 OYATE CIR
LOWER BRULE SD
57548-8500
US

IV. Provider business mailing address

187 OYATE CIR
LOWER BRULE SD
57548-8500
US

V. Phone/Fax

Practice location:
  • Phone: 605-473-5584
  • Fax:
Mailing address:
  • Phone: 605-473-5584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6998
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: