Healthcare Provider Details

I. General information

NPI: 1528930385
Provider Name (Legal Business Name): CHRISTY CANADA WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 EXECUTIVE DR
JACKSON TN
38305-2318
US

IV. Provider business mailing address

101 EXECUTIVE DR
JACKSON TN
38305-2318
US

V. Phone/Fax

Practice location:
  • Phone: 731-300-3372
  • Fax:
Mailing address:
  • Phone: 731-300-3372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number26373
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: