Healthcare Provider Details

I. General information

NPI: 1184665101
Provider Name (Legal Business Name): CHRISTI D. ANDERSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTI D. OTTEN PA-C

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 03/09/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17611 SOUTH MUSKOGEE AVE CHEROKEE NATION
TAHLEQUAH OK
74464
US

IV. Provider business mailing address

14066 HIGHWAY 82
TAHLEQUAH OK
74464-6261
US

V. Phone/Fax

Practice location:
  • Phone: 918-207-4911
  • Fax: 918-458-6221
Mailing address:
  • Phone: 918-931-8935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1527
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: