Provider Demographics
NPI:1336201128
Name:OKELLY, CHRISTINE R (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:R
Last Name:OKELLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 MEDICAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1181
Mailing Address - Country:US
Mailing Address - Phone:606-784-6641
Mailing Address - Fax:606-780-2374
Practice Address - Street 1:234 MEDICAL CIRCLE
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1181
Practice Address - Country:US
Practice Address - Phone:606-784-6641
Practice Address - Fax:606-780-2374
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2978P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78003142Medicaid
KY3002978OtherSTATE LICENSE
KYK074990Medicare PIN