Provider Demographics
NPI:1407288640
Name:MARTIN, CHRISTOPHER P (RN)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:P
Last Name:MARTIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MEDICINE LODGE
Mailing Address - State:KS
Mailing Address - Zip Code:67104-1019
Mailing Address - Country:US
Mailing Address - Phone:620-886-3771
Mailing Address - Fax:620-930-3784
Practice Address - Street 1:710 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MEDICINE LODGE
Practice Address - State:KS
Practice Address - Zip Code:67104-1019
Practice Address - Country:US
Practice Address - Phone:620-886-3771
Practice Address - Fax:620-930-3784
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-108020163W00000X
KSTMP 147333363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse