Active NPI
Christina Lynn Bennett, CNM
- Adult Health Nurse Practitioner
- Anderson, IN
National Provider Identifier
1003917774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 72000043A
- Practice address
- 1931 Brown St
Anderson, IN 46016-4206 - Phone
- (765) 646-8247
- NPI assigned
- Sep 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | 72000043A | IN | |
| Obstetrics & Gynecology Nurse Practitioner | 363LX0001X | 72000043A | IN | |
| Advanced Practice Midwife | 367A00000X | 72000043A | IN | |
| Adult Health Nurse Practitioner | 363LA2200X | 72000043A | IN | Primary |
Addresses
Primary practice location
1931 Brown St
Anderson, IN 46016-4206
Mailing address
1931 Brown St Ste a
Anderson, IN 46016-4206
Phone (765) 425-7454
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200531440 | Medicaid | IN | |
| 200272370 | Medicaid | IN |
Other names 1
- Ms. Christina Lynn Dix Jackey
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 72000043A | IN | MD | Adult Health Nurse Practitioner |
Interoperability endpoints
- christina.jackey.2@7598.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583193600000",
"number": "1003917774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1931 BROWN ST STE A",
"city": "ANDERSON",
"state": "IN",
"postal_code": "460164206",
"telephone_number": "765-425-7454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1931 BROWN ST",
"city": "ANDERSON",
"state": "IN",
"postal_code": "460164206",
"telephone_number": "765-646-8247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "CHRISTINA",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "CNM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-26",
"last_updated": "2020-03-03",
"certification_date": "2020-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "363LW0102X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Women's Health",
"state": "IN",
"license": "72000043A",
"primary": false
},
{
"code": "363LX0001X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Obstetrics & Gynecology",
"state": "IN",
"license": "72000043A",
"primary": false
},
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "IN",
"license": "72000043A",
"primary": false
},
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "IN",
"license": "72000043A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200531440",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200272370",
"state": "IN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "CHRISTINA",
"last_name": "JACKEY",
"middle_name": "LYNN DIX",
"prefix": "MS.",
"credential": "CNM",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Anderson, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.