Provider Demographics
NPI:1508868480
Name:RABETOY, CHRISTY A (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:A
Last Name:RABETOY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 ALLISON TIMBERS RD
Mailing Address - Street 2:
Mailing Address - City:PINEY FLATS
Mailing Address - State:TN
Mailing Address - Zip Code:37686-4043
Mailing Address - Country:US
Mailing Address - Phone:423-391-7313
Mailing Address - Fax:
Practice Address - Street 1:116 ALLISON TIMBERS RD
Practice Address - Street 2:
Practice Address - City:PINEY FLATS
Practice Address - State:TN
Practice Address - Zip Code:37686-4043
Practice Address - Country:US
Practice Address - Phone:423-319-7313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000013125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
005537602Medicare ID - Type Unspecified
UT588032Medicare UPIN