Healthcare Provider Details

I. General information

NPI: 1073393815
Provider Name (Legal Business Name): ISABELLE ABRAHAM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN STE B332
DALLAS TX
75230-6822
US

IV. Provider business mailing address

PO BOX 603725
CHARLOTTE NC
28260-3725
US

V. Phone/Fax

Practice location:
  • Phone: 972-566-7788
  • Fax: 972-566-8837
Mailing address:
  • Phone: 828-575-2625
  • Fax: 828-350-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17188
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: