Provider Demographics
NPI:1689167975
Name:GAMMER, CHRISTINA LASHELL (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:LASHELL
Last Name:GAMMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 GRAINGER ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3261
Mailing Address - Country:US
Mailing Address - Phone:817-336-3968
Mailing Address - Fax:817-336-7817
Practice Address - Street 1:800 5TH AVE STE 500
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7304
Practice Address - Country:US
Practice Address - Phone:817-250-4280
Practice Address - Fax:817-250-4281
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137127363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner