Healthcare Provider Details

I. General information

NPI: 1053349175
Provider Name (Legal Business Name): CHRISTINA ANNE FAULKNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 12TH AVE STE 104
EMPORIA KS
66801-2588
US

IV. Provider business mailing address

1201 W 12TH AVE
EMPORIA KS
66801-2504
US

V. Phone/Fax

Practice location:
  • Phone: 620-343-2376
  • Fax: 620-341-7740
Mailing address:
  • Phone: 620-343-6800
  • Fax: 620-341-7821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number04-33107
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: