Provider Demographics
NPI:1073588539
Name:MARTIN, CHRISTA D (CNS)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:D
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 11019 ASU
Mailing Address - Street 2:1901 JOHNSON STREET
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76909-1019
Mailing Address - Country:US
Mailing Address - Phone:325-942-2171
Mailing Address - Fax:325-942-2133
Practice Address - Street 1:BOX 11019 ASU
Practice Address - Street 2:1901 JOHNSON STREET
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76909-1019
Practice Address - Country:US
Practice Address - Phone:325-942-2171
Practice Address - Fax:325-942-2133
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX540682364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176201501Medicaid
TXQ25835Medicare UPIN
TX176201501Medicaid