1245620079 NPI number — CHRISTINA MARIE HARRISON AGNP-BC

Table of content: CHRISTINA MARIE HARRISON AGNP-BC (NPI 1245620079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245620079 NPI number — CHRISTINA MARIE HARRISON AGNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRISON
Provider First Name:
CHRISTINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AGNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245620079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1231
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRYSON CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28713-1231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-693-3410
Provider Business Mailing Address Fax Number:
828-538-4441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10210 HICKORYWOOD HILL AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28078-3417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-274-9084
Provider Business Practice Location Address Fax Number:
828-538-4441
Provider Enumeration Date:
02/02/2015

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:  5011028 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com