Healthcare Provider Details

I. General information

NPI: 1992706121
Provider Name (Legal Business Name): CHRISTOPHER CHARLES BERNETT PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2854 BELL ST
ZANESVILLE OH
43701-1721
US

IV. Provider business mailing address

2854 BELL ST
ZANESVILLE OH
43701-1721
US

V. Phone/Fax

Practice location:
  • Phone: 740-454-3273
  • Fax: 740-588-1081
Mailing address:
  • Phone: 740-454-3273
  • Fax: 740-588-1081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2002016775
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50002802
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: