Provider Demographics
NPI:1033177837
Name:BLACK, CHRISTA M (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:M
Last Name:BLACK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 FLOYD CURL DR FL 4
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3931
Mailing Address - Country:US
Mailing Address - Phone:210-450-9200
Mailing Address - Fax:210-450-6013
Practice Address - Street 1:8300 FLOYD CURL DR FL 4
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3931
Practice Address - Country:US
Practice Address - Phone:210-450-9200
Practice Address - Fax:210-450-6013
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004943363A00000X
TXPA05376363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1033177837Medicaid
VAVVH950AOtherMEDICARE
VA1033177837Medicaid
TX381555YK00Medicare PIN
P50236Medicare UPIN
NEP50236Medicare UPIN
NE276945Medicare ID - Type Unspecified