Provider Demographics
NPI:1659611903
Name:WEATHERFORD, CHRISTINA NICHOLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:NICHOLE
Last Name:WEATHERFORD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11185 PEE DEE RD S
Mailing Address - Street 2:
Mailing Address - City:GALIVANTS FERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29544-8941
Mailing Address - Country:US
Mailing Address - Phone:843-877-9353
Mailing Address - Fax:
Practice Address - Street 1:823 82ND PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4607
Practice Address - Country:US
Practice Address - Phone:843-449-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC30233134OtherSELECT HEALTH
SC1184113OtherWELLCARE
SC1659611903OtherCONSUMERS CHOICE
SC3670218OtherUNITED HEALTHCARE
SC80058760OtherSELECT HEALTH
SCNP2400Medicaid
SCSC0985B865OtherMEDICARE
SCP01553934OtherRR MEDICARE
SC4166115OtherAETNA
SC80058760OtherSELECT HEALTH