Provider Demographics
NPI:1578098570
Name:RAYMER, CHRIS LEE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:LEE
Last Name:RAYMER
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4437 E MAIN ST APT 6
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-8401
Mailing Address - Country:US
Mailing Address - Phone:662-315-8549
Mailing Address - Fax:
Practice Address - Street 1:4437 E MAIN ST APT 6
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-8401
Practice Address - Country:US
Practice Address - Phone:662-315-8549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005134363LF0000X
MO2017038724363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily