Provider Demographics
NPI:1336242619
Name:COLEY, CHRISTINA (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:COLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1602 W AVENUE A
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-4080
Mailing Address - Country:US
Mailing Address - Phone:254-899-2225
Mailing Address - Fax:254-899-2225
Practice Address - Street 1:1602 W AVENUE A
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-4080
Practice Address - Country:US
Practice Address - Phone:254-899-2225
Practice Address - Fax:254-899-2225
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700811363L00000X
OH09458-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9700811OtherSTATE LICENSE NUMBER
OHCOA.09458-NPOtherSTATE LICENSE NUMBER
OHCOA.09458-NPOtherSTATE LICENSE NUMBER
OHMS1454521OtherDEA
NCMS1454521OtherDEA
NC2592750Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER