Provider Demographics
NPI:1760753081
Name:WATERS, CRISTY L (PA-C)
Entity type:Individual
Prefix:
First Name:CRISTY
Middle Name:L
Last Name:WATERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CRISTY
Other - Middle Name:L
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-838-8265
Mailing Address - Fax:
Practice Address - Street 1:7061 GRAND MONTECITO PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-0287
Practice Address - Country:US
Practice Address - Phone:702-243-8500
Practice Address - Fax:208-524-2821
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2436363A00000X
NVPA0571363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant