Healthcare Provider Details

I. General information

NPI: 1851934970
Provider Name (Legal Business Name): CHRISTINA LEE EXUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 CAROL ANN DR
KERRVILLE TX
78028-3414
US

IV. Provider business mailing address

1309 CAROL ANN DR
KERRVILLE TX
78028-3414
US

V. Phone/Fax

Practice location:
  • Phone: 830-992-1557
  • Fax:
Mailing address:
  • Phone: 830-992-1557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP143568
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: