Provider Demographics
NPI:1093086761
Name:BRAMWELL, CHRISTY LIN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:LIN
Last Name:BRAMWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711-1287
Mailing Address - Country:US
Mailing Address - Phone:417-926-1770
Mailing Address - Fax:417-926-1785
Practice Address - Street 1:1905 W 19TH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GROVE
Practice Address - State:MO
Practice Address - Zip Code:65711-1287
Practice Address - Country:US
Practice Address - Phone:417-926-1770
Practice Address - Fax:417-926-1785
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012002377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26D2006074OtherCLIA
MO420012684Medicaid