Basic Information
Provider Information
NPI: 1245761360
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WRIGHT
FirstName: CHRISTINE
MiddleName: JOHNS
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 4594
Address2:  
City: BILOXI
State: MS
PostalCode: 395354594
CountryCode: US
TelephoneNumber: 2282734096
FaxNumber: 2285941765
Practice Location
Address1: 180 DEBUYS RD
Address2:  
City: BILOXI
State: MS
PostalCode: 395314402
CountryCode: US
TelephoneNumber: 2282734096
FaxNumber: 2285941765
Other Information
ProviderEnumerationDate: 03/21/2017
LastUpdateDate: 03/21/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X901987MSY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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