Basic Information
Provider Information
NPI: 1558875500
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABERNATHY
FirstName: BRITTANY
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4324 HILLSBORO HEMATITE RD
Address2:  
City: FESTUS
State: MO
PostalCode: 630283068
CountryCode: US
TelephoneNumber: 3147794684
FaxNumber:  
Practice Location
Address1: 3401 CIVIC CENTER BLVD
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191044319
CountryCode: US
TelephoneNumber: 2155901000
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/29/2017
LastUpdateDate: 11/02/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/02/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200XSPAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics

No ID Information.


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