Provider Demographics
NPI:1841396413
Name:MASTERMAN, CHRISTY B (ARNP)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:B
Last Name:MASTERMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 W 27TH PL STE 301
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-2909
Mailing Address - Country:US
Mailing Address - Phone:509-303-3428
Mailing Address - Fax:509-436-7271
Practice Address - Street 1:4309 W 27TH PL STE 301
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-2909
Practice Address - Country:US
Practice Address - Phone:509-303-3428
Practice Address - Fax:509-436-7271
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007389363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2050303Medicaid
WAG8948203Medicare PIN