Basic Information
| Provider Information | |||||||||
| NPI: | 1528478518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHRISTY | ||||||||
| FirstName: | CONNIE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN CDE | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8083 COUNTY ROAD 1460 | ||||||||
| Address2: | |||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748200554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804211511 | ||||||||
| FaxNumber: | 5802721720 | ||||||||
| Practice Location | |||||||||
| Address1: | 8083 COUNTY ROAD 1460 | ||||||||
| Address2: | |||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748200554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804211511 | ||||||||
| FaxNumber: | 5802721720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2014 | ||||||||
| LastUpdateDate: | 04/30/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WD0400X | R 0053448 | OK | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator |
No ID Information.