Provider Demographics
NPI:1619798956
Name:MINOR, CHRISTY EILEEN (APRN)
Entity type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:EILEEN
Last Name:MINOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-3310
Mailing Address - Country:US
Mailing Address - Phone:812-801-0800
Mailing Address - Fax:
Practice Address - Street 1:630 BROADWAY ST # 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-3310
Practice Address - Country:US
Practice Address - Phone:812-801-0995
Practice Address - Fax:812-801-8621
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015919A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7101026100Medicaid
IN300098974Medicaid