1144803958 NPI number — MS. CHRISTINE GRAY UDALL APRN, MSN, FNP-C

Table of content: MS. CHRISTINE GRAY UDALL APRN, MSN, FNP-C (NPI 1144803958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144803958 NPI number — MS. CHRISTINE GRAY UDALL APRN, MSN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UDALL
Provider First Name:
CHRISTINE
Provider Middle Name:
GRAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, MSN, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
UDALL
Provider Other First Name:
CHRISTY
Provider Other Middle Name:
GRAY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1144803958
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4500 MERCANTILE PLAZA DR
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76137-4206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-949-0108
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
399 REID RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JUNCTION
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76849-3049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-307-7084
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  F04210359 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)