MEDICARE: PATRICIA G CHRISTY NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN045342AP03965	LA

General Provider Information

NPI Number	:	1376546739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA G CHRISTY NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	1736 W. PRIEN LAKE ROAD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601
Country	:	US
Telephone Number	:	337-478-5085
Fax Number	:	337-478-5086

Provider Business Practice Location Address
First Line	:	1736 W. PRIEN LAKE ROAD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601
Country	:	US
Telephone Number	:	337-478-5085
Fax Number	:	337-478-5086

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	01/29/2009

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