MEDICARE: DR. CRISTIAN BLAKE SKINNER DO, PHD, ABPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	4086	WV
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2084P0800X	Psychiatry Physician	2024-00137	NC

General Provider Information

NPI Number	:	1538620422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRISTIAN BLAKE SKINNER DO, PHD, ABPN

Provider Business Mailing Address
First Line	:	7200 CREEDMOOR RD STE 200
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-1711
Country	:	US
Telephone Number	:	919-912-5600
Fax Number	:	800-887-8477

Provider Business Practice Location Address
First Line	:	7200 CREEDMOOR RD STE 200
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-1711
Country	:	US
Telephone Number	:	919-912-5600
Fax Number	:	800-887-8477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	07/22/2024

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