Healthcare Provider Details

I. General information

NPI: 1528578838
Provider Name (Legal Business Name): CHRISTY ANN HOLSTEIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35767 POND FORK ROAD
WHARTON WV
25208
US

IV. Provider business mailing address

37456 COAL RIVER RD
WHITESVILLE WV
25209
US

V. Phone/Fax

Practice location:
  • Phone: 304-247-6202
  • Fax: 304-247-6203
Mailing address:
  • Phone: 304-854-1321
  • Fax: 304-854-1031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN69417NP
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: