Provider Demographics
NPI:1861597874
Name:MUCKENHAUSEN, CHRISTA (MD)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:MUCKENHAUSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTA-ULRIKE
Other - Middle Name:
Other - Last Name:MUCKENHAUSEN-JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2668
Mailing Address - Country:US
Mailing Address - Phone:606-432-6004
Mailing Address - Fax:606-432-6644
Practice Address - Street 1:100 LR JOHNSON DR
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501
Practice Address - Country:US
Practice Address - Phone:606-432-6004
Practice Address - Fax:606-432-6644
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY182582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C78347Medicare UPIN