Provider Demographics
NPI:1477919256
Name:FLEMING, CHRISTA MARTINA (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:MARTINA
Last Name:FLEMING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 HYANNIS DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-8336
Mailing Address - Country:US
Mailing Address - Phone:919-363-8666
Mailing Address - Fax:919-363-8668
Practice Address - Street 1:107 HYANNIS DR
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-8336
Practice Address - Country:US
Practice Address - Phone:919-363-8666
Practice Address - Fax:919-363-8668
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001006140207Q00000X
261QM1300X, 261QP2300X, 261QU0200X, 363AM0700X
NC0010-06140363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1477919256Medicaid