MEDICARE: LEA A ABERNATHY ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	791	AK
2	363LF0000X	Family Nurse Practitioner	AP61034111	WA
3	363LF0000X	Family Nurse Practitioner	201099	NC

General Provider Information

NPI Number	:	1063582658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEA A ABERNATHY ANP

Provider Business Mailing Address
First Line	:	1202 MEDICAL CENTER DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-7307
Country	:	US
Telephone Number	:	910-341-1540
Fax Number	:	910-431-4048

Provider Business Practice Location Address
First Line	:	1300 BRIDGE BARRIER RD STE 2
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-3939
Country	:	US
Telephone Number	:	910-458-4101
Fax Number	:	910-458-5617

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	05/26/2023

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