Provider Demographics
NPI:1114962685
Name:WEDDINGTON, CHRISTINA ROTH (FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ROTH
Last Name:WEDDINGTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CHRISTINA
Other - Last Name:WEDDINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:1409 W GEORGIA RD
Practice Address - Street 2:SUITE B
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6419
Practice Address - Country:US
Practice Address - Phone:864-454-5000
Practice Address - Fax:864-454-5005
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1140Medicaid
SCP58774Medicare UPIN
SCP587747951Medicare PIN