Provider Demographics
NPI:1902463847
Name:OWEN, CHRISTIE MICHELLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:MICHELLE
Last Name:OWEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:MICHELLE
Other - Last Name:BOREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:6000 BRYANT IRVIN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4116
Mailing Address - Country:US
Mailing Address - Phone:817-229-4375
Mailing Address - Fax:
Practice Address - Street 1:6000 BRYANT IRVIN RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4116
Practice Address - Country:US
Practice Address - Phone:817-229-4375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-27
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily