Healthcare Provider Details

I. General information

NPI: 1336066208
Provider Name (Legal Business Name): CHRISTINA LEAANN GAINES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 BROADWAY ST
PADUCAH KY
42001-7110
US

IV. Provider business mailing address

4317 ALBEN BARKLEY DR
PADUCAH KY
42001-4841
US

V. Phone/Fax

Practice location:
  • Phone: 270-331-6743
  • Fax: 270-993-1205
Mailing address:
  • Phone: 270-558-8368
  • Fax: 270-993-1205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: