1700431145 NPI number — MS. STACY DONNIA CHRISTMAN CERTIFIED PEDORTHIST

Table of content: MS. STACY DONNIA CHRISTMAN CERTIFIED PEDORTHIST (NPI 1700431145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700431145 NPI number — MS. STACY DONNIA CHRISTMAN CERTIFIED PEDORTHIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTMAN
Provider First Name:
STACY
Provider Middle Name:
DONNIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CERTIFIED PEDORTHIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHRISTMAN
Provider Other First Name:
STACY
Provider Other Middle Name:
DONNIA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CERTIFIED PEDORTHIST
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1700431145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2007 CAMDEN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76013-4802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-746-0987
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1106 ALSTON AVE STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-4644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-335-1445
Provider Business Practice Location Address Fax Number:
817-336-1171
Provider Enumeration Date:
08/02/2019

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: 224L00000X , with the licence number:  CPED4496 , 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)





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