=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073384541
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABIGAIL GRACE HUSTON APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2024
-----------------------------------------------------
Last Update Date | 04/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7459 BURLINGTON PIKE
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41042-1553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-578-3200
-----------------------------------------------------
Fax | 859-534-2627
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3788 MILLSBRAE AVE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45209-2216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-405-9636
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | RN.478868
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 4027804
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------