Provider Demographics
NPI:1659594182
Name:CLICKARD, CHRISTINE (FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:CLICKARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 CASA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1804
Mailing Address - Country:US
Mailing Address - Phone:805-544-4883
Mailing Address - Fax:805-542-0827
Practice Address - Street 1:184 CASA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1804
Practice Address - Country:US
Practice Address - Phone:805-544-4883
Practice Address - Fax:805-542-0827
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258176363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA258176OtherMEDICAL LICENSE #
CA258176OtherMEDICAL LICENSE #