Provider Demographics
NPI:1598962870
Name:QUILLEN, CHRISTY MICHELLE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:MICHELLE
Last Name:QUILLEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1908
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-1908
Mailing Address - Country:US
Mailing Address - Phone:903-454-3025
Mailing Address - Fax:903-450-1408
Practice Address - Street 1:91 W SIDE SQ
Practice Address - Street 2:
Practice Address - City:COOPER
Practice Address - State:TX
Practice Address - Zip Code:75432-1725
Practice Address - Country:US
Practice Address - Phone:903-395-0586
Practice Address - Fax:903-395-0589
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA101966363LF0000X
NE110894363LF0000X
TXAP133932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily