Provider Demographics
NPI:1992450696
Name:STARK, CHRISTOPHER CLAYTON (MSN, FNP-BC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:CLAYTON
Last Name:STARK
Suffix:
Gender:M
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21202 BAY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-3646
Mailing Address - Country:US
Mailing Address - Phone:717-682-5051
Mailing Address - Fax:
Practice Address - Street 1:1058 S GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-6920
Practice Address - Country:US
Practice Address - Phone:302-382-8698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0011901363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily