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General NPI Number Information
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NPI Number | 1205895745
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Entity Type | Individual
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Provider Name | CHRISTINA A JETTON MD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 1430 W C ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-2805
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Country | US
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Telephone | 479-968-6781
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Fax | 479-968-3074
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Provider Business Mailing Address
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Address Line | PO BOX 925
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City | RUSSELLVILLE
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State | AR
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Zip | 72811-0925
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Country | US
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Telephone | 479-968-6781
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Fax | 479-968-3074
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | E2643
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License Number State | AR
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