Provider Demographics
NPI:1538653365
Name:CHRISTIE, JAMES JR
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CHRISTIE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 OSAGE ST
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-1612
Mailing Address - Country:US
Mailing Address - Phone:580-677-2469
Mailing Address - Fax:
Practice Address - Street 1:4323 OSAGE ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-1612
Practice Address - Country:US
Practice Address - Phone:580-677-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator