Individual
ABBY PROVENCAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
842 YELLOW SPRINGS RD, COSBY, TN 37722-3443
(423) 721-2929
Mailing address
842 YELLOW SPRINGS RD, COSBY, TN 37722-3443
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
29912
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29912
APRN LICENSE NUMBER
TN
Enumeration date
07/21/2021
Last updated
07/21/2021
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