Provider Demographics
NPI:1740824895
Name:HOUSE, CHRISTY TIMOTHEA (FNP)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:TIMOTHEA
Last Name:HOUSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:TIMOTHEA
Other - Last Name:COFFEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1162 E SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-2729
Mailing Address - Country:US
Mailing Address - Phone:219-440-6626
Mailing Address - Fax:
Practice Address - Street 1:1162 E SUMMIT ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-2729
Practice Address - Country:US
Practice Address - Phone:219-440-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-01
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.464769163W00000X
IN28246265A163W00000X
OHAPRN.CNP.025360363L00000X
IN71012767A363L00000X
ID71012767A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty