Healthcare Provider Details

I. General information

NPI: 1134737158
Provider Name (Legal Business Name): CHRISTOPHER LAWRENCE DEMATT FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14254 S PADRE ISLAND DR
CORPUS CHRISTI TX
78418-6277
US

IV. Provider business mailing address

5402 ARMSTRONG DR
CORPUS CHRISTI TX
78413-6217
US

V. Phone/Fax

Practice location:
  • Phone: 361-589-4068
  • Fax:
Mailing address:
  • Phone: 361-563-2280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1003337
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: