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General NPI Number Information
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NPI Number | 1215173679
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Entity Type | Individual
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Provider Name | CHRISTOPHER SCOTT BRACKMAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/06/2009
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Last Update Date | 08/03/2012
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Provider Practice Location Address
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Address Line | 2194 BOOTH RD
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City | KENOVA
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State | WV
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Zip | 25530-9544
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Country | US
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Telephone | 304-453-6351
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Fax |
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Provider Business Mailing Address
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Address Line | 2194 BOOTH RD
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City | KENOVA
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State | WV
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Zip | 25530-9544
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Country | US
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Telephone | 304-453-1635
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 010-01314
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License Number State | NC
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