Provider Demographics
NPI:1619230265
Name:CHRISTIAN, AMBER GRACE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:GRACE
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:GRACE
Other - Last Name:GREENLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7345 HIGHWAY 62 W
Mailing Address - Street 2:
Mailing Address - City:GASSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72635-8636
Mailing Address - Country:US
Mailing Address - Phone:870-435-5511
Mailing Address - Fax:870-435-5513
Practice Address - Street 1:7345 HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:GASSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72635-8636
Practice Address - Country:US
Practice Address - Phone:870-435-5511
Practice Address - Fax:870-435-5513
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator