Provider Demographics
NPI:1477582146
Name:LEQUAN, CHRISTINA (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:LEQUAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SAUNDERSVILLE RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-8903
Mailing Address - Country:US
Mailing Address - Phone:423-567-5003
Mailing Address - Fax:423-790-7136
Practice Address - Street 1:260 16TH AVE
Practice Address - Street 2:UNIT 138
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-1071
Practice Address - Country:US
Practice Address - Phone:423-567-5003
Practice Address - Fax:423-428-9018
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000001269363A00000X
GA004870363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I977104Medicare PIN
GA97WCHZSMedicare PIN
Q56013Medicare UPIN
TNP00319227Medicare PIN
GA97WCHZSMedicare PIN
TN3663981Medicaid