1659611903 NPI number — CHRISTINA NICHOLE WEATHERFORD FNP-C

Table of content: CHRISTINA NICHOLE WEATHERFORD FNP-C (NPI 1659611903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659611903 NPI number — CHRISTINA NICHOLE WEATHERFORD FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEATHERFORD
Provider First Name:
CHRISTINA
Provider Middle Name:
NICHOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
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:
1659611903
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11185 PEE DEE RD S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALIVANTS FERRY
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29544-8941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-877-9353
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
823 82ND PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29572-4607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-449-1010
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2013

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: 363LF0000X , with the licence number:  18010 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30233134 . This is a "SELECT HEALTH" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 1184113 . This is a "WELLCARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 1659611903 . This is a "CONSUMERS CHOICE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 3670218 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 80058760 . This is a "SELECT HEALTH" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: NP2400 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: SC0985B865 . This is a "MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: P01553934 . This is a "RR MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 4166115 . This is a "AETNA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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