Provider Demographics
NPI:1457767162
Name:DURRETT, CHRISTINA ASHLEY (LAC DPI DM (NCC AO)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ASHLEY
Last Name:DURRETT
Suffix:
Gender:F
Credentials:LAC DPI DM (NCC AO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6647 OAK HILL BLVD.
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703
Mailing Address - Country:US
Mailing Address - Phone:903-787-5842
Mailing Address - Fax:903-787-5843
Practice Address - Street 1:6647 OAK HILL BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703
Practice Address - Country:US
Practice Address - Phone:903-787-5842
Practice Address - Fax:903-787-5843
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01493171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist