Basic Information
| Provider Information | |||||||||
| NPI: | 1942937057 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAVAGE | ||||||||
| FirstName: | CHRISTY | ||||||||
| MiddleName: | D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 HAL GREER BLVD | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257014114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043996610 | ||||||||
| FaxNumber: | 3043996621 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 HAL GREER BLVD | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257014114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043996572 | ||||||||
| FaxNumber: | 3046996571 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2022 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 112650 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 005021229 | 01 | WV | HIGHMARK | OTHER | WVD498A | 01 | WV | MEDICARE | OTHER | 1942937057 | 05 | WV | MEDICAID | 7100840640 | 05 | KY | MEDICAID |