Healthcare Provider Details

I. General information

NPI: 1508588526
Provider Name (Legal Business Name): CHRISTINA J HUMBER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 HIDDEN FALLS DR
GILMER TX
75645-0101
US

IV. Provider business mailing address

258 HIDDEN FALLS DR
GILMER TX
75645-0101
US

V. Phone/Fax

Practice location:
  • Phone: 903-806-0214
  • Fax:
Mailing address:
  • Phone: 903-806-0214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number789435
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number789435
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1099883
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: