Provider Demographics
NPI:1093481038
Name:SHIELDS, CHRISTINA MARIE (CPNP-AC/PC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:CPNP-AC/PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507A OLD BRANDON RD
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-4604
Mailing Address - Country:US
Mailing Address - Phone:601-531-8020
Mailing Address - Fax:601-345-2124
Practice Address - Street 1:2507A OLD BRANDON RD
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-4604
Practice Address - Country:US
Practice Address - Phone:601-531-8020
Practice Address - Fax:601-345-2124
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904172208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics