Provider Demographics
NPI:1891947693
Name:TYSON, CHRISTINA FORBES (PA)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:FORBES
Last Name:TYSON
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:217 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346-2527
Mailing Address - Country:US
Mailing Address - Phone:225-473-3931
Mailing Address - Fax:225-473-3289
Practice Address - Street 1:154 HIGHWAY 1008
Practice Address - Street 2:
Practice Address - City:NAPOLEONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70390-2009
Practice Address - Country:US
Practice Address - Phone:985-369-1880
Practice Address - Fax:985-369-9191
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200.199363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1357081Medicaid
LA5F973PA51Medicare Oscar/Certification