Provider Demographics
NPI:1447421482
Name:SKINNER, CHRISTIE FAYE (APN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:FAYE
Last Name:SKINNER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:CHRISTIE
Other - Middle Name:FAYE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-3711
Mailing Address - Country:US
Mailing Address - Phone:870-881-8008
Mailing Address - Fax:870-862-7374
Practice Address - Street 1:1000 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-3711
Practice Address - Country:US
Practice Address - Phone:870-881-8008
Practice Address - Fax:870-862-7374
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03087363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR167235758Medicaid
AR5A801Medicare PIN