Provider Demographics
NPI:1487654943
Name:WILSON, CHRISTINA HOLDER (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:HOLDER
Last Name:WILSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB-316
Mailing Address - Street 2:6800 W GATE BLVD #132
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4868
Mailing Address - Country:US
Mailing Address - Phone:512-217-7283
Mailing Address - Fax:
Practice Address - Street 1:4409 GAINES RANCH LOOP
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-6555
Practice Address - Country:US
Practice Address - Phone:512-217-7283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1466213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1121865-02Medicaid
TXU76664Medicare UPIN