Provider Demographics
NPI:1265323257
Name:COKE, CHRISTINA BRITTNEY
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:BRITTNEY
Last Name:COKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 MARLIN ST APT 34
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:42450-1251
Mailing Address - Country:US
Mailing Address - Phone:203-953-6513
Mailing Address - Fax:
Practice Address - Street 1:2000 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-9185
Practice Address - Country:US
Practice Address - Phone:270-825-4379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1177113390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program