Provider Demographics
NPI:1487693115
Name:CHRISTIE, PATRICE (PA-C)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 WILSON DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1864
Mailing Address - Country:US
Mailing Address - Phone:937-372-1602
Mailing Address - Fax:937-372-0154
Practice Address - Street 1:244 WILSON DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1864
Practice Address - Country:US
Practice Address - Phone:937-372-1602
Practice Address - Fax:937-372-0154
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50000476363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000378966OtherANTHEM
OHP52407Medicare UPIN
OH000000378966OtherANTHEM
OH18701Medicare PIN
OHPA18702Medicare ID - Type Unspecified