Basic Information
| Provider Information | |||||||||
| NPI: | 1710353487 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | ABIGAIL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 841656 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752841656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035315000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 115 AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | SULPHUR SPRINGS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754822105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038857671 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2015 | ||||||||
| LastUpdateDate: | 04/27/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | CNP-03179 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 8536NR | 01 | TX | BCBS | OTHER | 8821NS | 01 | TX | BCBS | OTHER | P01536083 | 01 | TX | RAIL ROAD | OTHER | 75-0818167-048 | 01 | TX | TRICARE | OTHER | 75-2616977-001 | 01 | TX | TRICARE | OTHER | 8422NS | 01 | TX | BCBS | OTHER | 8535NR | 01 | TX | BCBS | OTHER | P01536084 | 01 | TX | RAIL ROAD | OTHER | 349884201 | 05 | TX | MEDICAID | 75-0818167-044 | 01 | TX | TRICARE | OTHER | 75-2616977-028 | 01 | TX | TRICARE | OTHER | 3498842022 | 05 | TX | MEDICAID | 75-1976930-005 | 01 | TX | TRICARE | OTHER | P01536090 | 01 | TX | RAIL ROAD | OTHER | 75-0818167-015 | 01 | TX | TRICARE | OTHER | 75-0818167-022 | 01 | TX | TRICARE | OTHER | 75-2616977-002 | 01 | TX | TRICARE | OTHER |