Basic Information
| Provider Information | |||||||||
| NPI: | 1306832001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WESTBROOK | ||||||||
| FirstName: | CHRISTIE | ||||||||
| MiddleName: | ISENHOUR | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1850 W ARLINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278345704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524136740 | ||||||||
| FaxNumber: | 2527526600 | ||||||||
| Practice Location | |||||||||
| Address1: | 744 AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | KINSTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285048800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525230026 | ||||||||
| FaxNumber: | 2525231855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 10/13/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 103115 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 01960 | 01 | NC | BCBS GROUP NUMBER | OTHER | 5908296 | 01 | NC | EASTERN CAROLINA PHYSICIANS MEDICAID GROUP NUMBER FOR BEULAVILLE | OTHER | 560989277 | 01 | GROUP TAX ID | OTHER | 1467405431 | 01 | NC | GROUP NPI NUMBER | OTHER | 8102517 | 05 | NC | MEDICAID | 8901960 | 01 | NC | EASTERN CAROLINA PHYSICIANS MEDICAID GROUP NUMBER FOR KINSTON | OTHER | 0326 | 01 | NC | MEDICARE GROUP NUMBER | OTHER |