Provider Demographics
NPI:1639428519
Name:GRASS, CHRISTINE D (APRN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:D
Last Name:GRASS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1599 PERSIMMON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-7007
Mailing Address - Country:US
Mailing Address - Phone:502-523-9311
Mailing Address - Fax:866-902-0669
Practice Address - Street 1:1599 PERSIMMON RIDGE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-7007
Practice Address - Country:US
Practice Address - Phone:502-523-9311
Practice Address - Fax:866-902-0669
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
12438587OtherCAQH