Healthcare Provider Details

I. General information

NPI: 1245471150
Provider Name (Legal Business Name): CHRISTY MAHRT AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTY KIMLY

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date: 04/01/2009
Reactivation Date: 09/23/2021

III. Provider practice location address

1005 N PINE ST
ROLLA MO
65401-2824
US

IV. Provider business mailing address

611 W. PARK ST FAPC
URBANA IL
61801
US

V. Phone/Fax

Practice location:
  • Phone: 573-426-3350
  • Fax: 573-279-4680
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147001851
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: