Basic Information
| Provider Information | |||||||||
| NPI: | 1538778162 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOMBLIN | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | RYAN | ||||||||
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| Credential: | APRN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1347 HILLVIEW DR | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255411513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047431407 | ||||||||
| FaxNumber: | 3047434516 | ||||||||
| Practice Location | |||||||||
| Address1: | 1347 HILLVIEW DR | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255411513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047431407 | ||||||||
| FaxNumber: | 3047434516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2020 | ||||||||
| LastUpdateDate: | 09/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 107149 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.