Provider Demographics
NPI:1144765330
Name:FUNK, CHRISTY S (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:S
Last Name:FUNK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:S
Other - Last Name:BARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5206 SUNNYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-3497
Mailing Address - Country:US
Mailing Address - Phone:435-864-8330
Mailing Address - Fax:
Practice Address - Street 1:901 INDIANA AVE STE 540
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-6734
Practice Address - Country:US
Practice Address - Phone:940-249-5253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10181846-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
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