Provider Demographics
NPI:1255031498
Name:ETTERS, CHRISTINA (FNP-C)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:ETTERS
Suffix:
Gender:F
Credentials:FNP-C
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 86
Mailing Address - Street 2:
Mailing Address - City:LENORE
Mailing Address - State:WV
Mailing Address - Zip Code:25676-0086
Mailing Address - Country:US
Mailing Address - Phone:304-784-1168
Mailing Address - Fax:
Practice Address - Street 1:464 GRADE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:LENORE
Practice Address - State:WA
Practice Address - Zip Code:25676
Practice Address - Country:US
Practice Address - Phone:304-784-1168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3019083363LF0000X
WV115641363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily