Basic Information
| Provider Information | |||||||||
| NPI: | 1821413857 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABRAHAM | ||||||||
| FirstName: | JOHNY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 926 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 789342215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9799429084 | ||||||||
| FaxNumber: | 7186402713 | ||||||||
| Practice Location | |||||||||
| Address1: | 1249 DEER RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | LEAGUE CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775735203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813328163 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2014 | ||||||||
| LastUpdateDate: | 09/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP114875 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.