Provider Demographics
NPI:1174101588
Name:PECKENS, ABIGAIL FAITH
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:FAITH
Last Name:PECKENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 LONE TREE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:WV
Mailing Address - Zip Code:26170-9017
Mailing Address - Country:US
Mailing Address - Phone:304-305-0128
Mailing Address - Fax:
Practice Address - Street 1:169 LONE TREE LN
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:WV
Practice Address - Zip Code:26170-9017
Practice Address - Country:US
Practice Address - Phone:304-305-0128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant