Healthcare Provider Details

I. General information

NPI: 1265336002
Provider Name (Legal Business Name): ABIGAIL R DJIDJOHO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ABIGAIL ROSE JONES PA-C

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 SUNNY SLOPE CT
CLARKSVILLE TN
37043-7871
US

IV. Provider business mailing address

288 SUNNY SLOPE CT
CLARKSVILLE TN
37043-7871
US

V. Phone/Fax

Practice location:
  • Phone: 402-769-5200
  • Fax:
Mailing address:
  • Phone: 402-769-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7257
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: