Provider Demographics
NPI:1376116814
Name:MARTIN, CHRISTIAN MCKENZIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:MCKENZIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:CHRISTIAN
Other - Middle Name:MCKENZIE
Other - Last Name:MILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:2217 SMOLTZ DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-0113
Mailing Address - Country:US
Mailing Address - Phone:803-440-7257
Mailing Address - Fax:
Practice Address - Street 1:500 LAKESHORE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4273
Practice Address - Country:US
Practice Address - Phone:803-818-6900
Practice Address - Fax:803-803-3277
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25185363LF0000X
NC5014765363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP8015Medicaid