Provider Demographics
NPI:1306832001
Name:WESTBROOK, CHRISTIE ISENHOUR (PAC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:ISENHOUR
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 W ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5704
Mailing Address - Country:US
Mailing Address - Phone:252-413-6740
Mailing Address - Fax:252-752-6600
Practice Address - Street 1:744 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-8800
Practice Address - Country:US
Practice Address - Phone:252-523-0026
Practice Address - Fax:252-523-1855
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103115363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01960OtherBCBS GROUP NUMBER
NC5908296OtherEASTERN CAROLINA PHYSICIANS MEDICAID GROUP NUMBER FOR BEULAVILLE
560989277OtherGROUP TAX ID
NC1467405431OtherGROUP NPI NUMBER
NC8102517Medicaid
NC8901960OtherEASTERN CAROLINA PHYSICIANS MEDICAID GROUP NUMBER FOR KINSTON
NC0326OtherMEDICARE GROUP NUMBER
NC5908296OtherEASTERN CAROLINA PHYSICIANS MEDICAID GROUP NUMBER FOR BEULAVILLE
NC8102517Medicaid