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General NPI Number Information
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NPI Number | 1053943217
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Entity Type | Individual
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Provider Name | JOERESTY TABUJARA ABELIDA AGACNP
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Gender | Male
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Dates
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Enumeration Date | 02/06/2020
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 825 NE 10TH ST STE 5B
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-5417
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Country | US
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Telephone | 405-271-3635
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Fax | 405-271-2523
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone | 864-522-8603
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | AP144916
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | AP144916
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 26046
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | 200190
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License Number State | OK
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