Provider Demographics
NPI:1750169132
Name:CHRISTY, VERONICA
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 HORTON AVE W
Mailing Address - Street 2:
Mailing Address - City:RAINELLE
Mailing Address - State:WV
Mailing Address - Zip Code:25962-1494
Mailing Address - Country:US
Mailing Address - Phone:304-237-0531
Mailing Address - Fax:
Practice Address - Street 1:199 HORTON AVE W
Practice Address - Street 2:
Practice Address - City:RAINELLE
Practice Address - State:WV
Practice Address - Zip Code:25962-1494
Practice Address - Country:US
Practice Address - Phone:304-237-0531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker