Provider Demographics
NPI:1225778624
Name:WALSTON, CHRISTIE SUMMERLIN (FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:SUMMERLIN
Last Name:WALSTON
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 1:1743 N FOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MACCLESFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27852-9305
Mailing Address - Country:US
Mailing Address - Phone:252-883-6986
Mailing Address - Fax:
Practice Address - Street 1:122 E SAINT JAMES ST
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-5016
Practice Address - Country:US
Practice Address - Phone:252-883-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCWALS-7XCVU363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily