Provider Demographics
NPI:1922273499
Name:TREPPENDAHL, CHRISTINA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:TREPPENDAHL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2746
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39130-2746
Mailing Address - Country:US
Mailing Address - Phone:601-366-0855
Mailing Address - Fax:
Practice Address - Street 1:1000 HIGHLAND COLONY PKWY
Practice Address - Street 2:SUITE 7205
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2073
Practice Address - Country:US
Practice Address - Phone:601-366-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR858785363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0121253Medicaid