Healthcare Provider Details

I. General information

NPI: 1710003926
Provider Name (Legal Business Name): CHRISTY RACHEL YETTER I MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 W LAMPASAS ST SUITE 205
ENNIS TX
75119-5644
US

IV. Provider business mailing address

710 CODY RD
ENNIS TX
75119-8830
US

V. Phone/Fax

Practice location:
  • Phone: 972-875-6200
  • Fax:
Mailing address:
  • Phone: 972-878-6227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: