Provider Demographics
NPI:1457011066
Name:PETERSON, CHRISTY LYNN (APRN, MSN, PNP-AC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:LYNN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:APRN, MSN, PNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4499 MEDICAL DR STE 289
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3712
Mailing Address - Country:US
Mailing Address - Phone:210-614-3264
Mailing Address - Fax:
Practice Address - Street 1:4499 MEDICAL DR STE 289
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3712
Practice Address - Country:US
Practice Address - Phone:210-614-3264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1062047363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care