Provider Demographics
NPI:1235226069
Name:SMITH, CRISTIE LYNN (CERTIFIED MEDICAL AS)
Entity Type:Individual
Prefix:MRS
First Name:CRISTIE
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CERTIFIED MEDICAL AS
Other - Prefix:MS
Other - First Name:CRISTIE
Other - Middle Name:LYNN
Other - Last Name:PFEIFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CERTIFIED MEDICAL AS
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:REA CLINIC
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62832
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-2571
Practice Address - Street 1:119 GAS PLANT RD
Practice Address - Street 2:REA CLINIC DU QUOIN
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832
Practice Address - Country:US
Practice Address - Phone:618-724-8702
Practice Address - Fax:618-724-2571
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical