Provider Demographics
NPI:1467473975
Name:COON, CHRISTY (PA)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:COON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ORTHOPEDIC WAY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-1629
Mailing Address - Country:US
Mailing Address - Phone:817-375-5375
Mailing Address - Fax:817-299-1706
Practice Address - Street 1:7999 W VIRGINIA DR
Practice Address - Street 2:STE D
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3844
Practice Address - Country:US
Practice Address - Phone:972-709-6911
Practice Address - Fax:972-298-5240
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03832363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03832OtherTX MEDICAL BOARD LICENSE
TX86441NMedicare PIN