Provider Demographics
NPI:1568781094
Name:MORTON, CHRISTINA NICHOLE
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:NICHOLE
Last Name:MORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:NICHOLE
Other - Last Name:MITCHEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2409 NW 190TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-2601
Mailing Address - Country:US
Mailing Address - Phone:405-248-2215
Mailing Address - Fax:
Practice Address - Street 1:2409 NW 190TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-2601
Practice Address - Country:US
Practice Address - Phone:405-248-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36347127171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator