Provider Demographics
NPI:1407175748
Name:FARRELL, CHRISTIE G (WHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:G
Last Name:FARRELL
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:MISS
Other - First Name:CHRISTIE
Other - Middle Name:E
Other - Last Name:GASKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP-BC
Mailing Address - Street 1:7130 GLEN FOREST DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3754
Mailing Address - Country:US
Mailing Address - Phone:804-288-4084
Mailing Address - Fax:804-282-8678
Practice Address - Street 1:12129 GRAHAM MEADOWS DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-6661
Practice Address - Country:US
Practice Address - Phone:804-288-4084
Practice Address - Fax:804-282-2601
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168760363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1407175748Medicaid
VAVVC293AMedicare PIN