Provider Demographics
NPI:1205917531
Name:MARTIN, CHRISTINA (APRN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4201
Mailing Address - Country:US
Mailing Address - Phone:502-409-9925
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:1107 CROWN POINTE DR STE 107
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-506-3300
Practice Address - Fax:270-506-2843
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3004027363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
000001189538OtherANTHEM ID
KY7100017960Medicaid
KY000000388244OtherBLUE CROSS FACETS ID
KY343528KYIPOtherAETNA BETTER HEALTH
9226249OtherAETNA PIN
CS1827500489OtherCARESOURCE ID
3205478OtherUNITED HEALTHCARE
1641617OtherWELLCARE
IN201078550Medicaid