Healthcare Provider Details

I. General information

NPI: 1194768226
Provider Name (Legal Business Name): CHRISTA MONROE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 MEDICAL CENTER CIR
MAYFIELD KY
42066-1159
US

IV. Provider business mailing address

76 OLD PENNY RD
HARDIN KY
42048-9613
US

V. Phone/Fax

Practice location:
  • Phone: 800-893-9698
  • Fax:
Mailing address:
  • Phone: 270-293-7547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3004489
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4489P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: