Provider Demographics
NPI:1831295062
Name:BINGHAM, CHRISTA WAI (PAC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTA
Middle Name:WAI
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 CORONA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1292
Mailing Address - Country:US
Mailing Address - Phone:859-224-3972
Mailing Address - Fax:
Practice Address - Street 1:VAMC 1101 VETERANS DRIVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-2236
Practice Address - Country:US
Practice Address - Phone:859-233-4511
Practice Address - Fax:859-281-4803
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY477363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant