Provider Demographics
NPI:1508189267
Name:LIVELY-HARRIS, CHRISTY ANN (MSPA-C)
Entity Type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:ANN
Last Name:LIVELY-HARRIS
Suffix:
Gender:F
Credentials:MSPA-C
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:A
Other - Last Name:LIVELY-WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPA-C
Mailing Address - Street 1:3157 ROBERT C BYRD DR
Mailing Address - Street 2:BRIAN S LOVE, MD INC
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3724
Mailing Address - Country:US
Mailing Address - Phone:304-253-9355
Mailing Address - Fax:304-253-3299
Practice Address - Street 1:3157 ROBERT C BYRD DR
Practice Address - Street 2:BRIAN S LOVE, MD INC
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3724
Practice Address - Country:US
Practice Address - Phone:304-253-9355
Practice Address - Fax:304-253-3299
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01436363A00000X
WVWV01436363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant