Basic Information
Provider Information
NPI: 1003142423
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHRISTIE
FirstName: KAYE-ANN
MiddleName: ANTONETTE
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 314 PACIFIC ST
Address2:  
City: BRIDGEPORT
State: CT
PostalCode: 066042132
CountryCode: US
TelephoneNumber: 2022868168
FaxNumber:  
Practice Location
Address1: 1504 TAUB LOOP
Address2:  
City: HOUSTON
State: TX
PostalCode: 77030
CountryCode: US
TelephoneNumber: 7138732000
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/19/2009
LastUpdateDate: 01/27/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X0110003079VAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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