Provider Demographics
NPI:1376546739
Name:CHRISTY, PATRICIA G (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:G
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 W. PRIEN LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601
Mailing Address - Country:US
Mailing Address - Phone:337-478-5085
Mailing Address - Fax:337-478-5086
Practice Address - Street 1:1736 W. PRIEN LAKE ROAD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601
Practice Address - Country:US
Practice Address - Phone:337-478-5085
Practice Address - Fax:337-478-5086
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN045342AP03965363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H039BC11Medicare PIN