Provider Demographics
NPI:1184665101
Name:ANDERSON, CHRISTI D (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTI
Middle Name:D
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHRISTI
Other - Middle Name:D
Other - Last Name:OTTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:14066 HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-6261
Mailing Address - Country:US
Mailing Address - Phone:918-931-8935
Mailing Address - Fax:
Practice Address - Street 1:17611 SOUTH MUSKOGEE AVE
Practice Address - Street 2:CHEROKEE NATION
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464
Practice Address - Country:US
Practice Address - Phone:918-207-4911
Practice Address - Fax:918-458-6221
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1527363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant