Active NPI
Stephannie Nicole Christian, PA-C
- Physician Assistant
- Fairbanks, AK
National Provider Identifier
1760699011
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA19107
- Practice address
- 122 1St Ave
Suite 600
Fairbanks, AK 99701-4803 - Phone
- (907) 452-8251
- Fax
- (907) 459-3851
- NPI assigned
- May 17, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA19107 | CA | Primary |
Addresses
Primary practice location
122 1St Ave
Suite 600
Fairbanks, AK 99701-4803
Mailing address
122 1St Ave
Suite 600
Fairbanks, AK 99701-4803
Phone (907) 452-8251
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA19107 | Other | CA | PHYSICIAN ASST. LICENSE |
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA19107 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248134400000",
"number": "1760699011",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "122 1ST AVE",
"address_2": "SUITE 600",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997014803",
"telephone_number": "907-452-8251",
"fax_number": "907-459-3851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "122 1ST AVE",
"address_2": "SUITE 600",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997014803",
"telephone_number": "907-452-8251",
"fax_number": "907-459-3851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHRISTIAN",
"first_name": "STEPHANNIE",
"middle_name": "NICOLE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-17",
"last_updated": "2009-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA19107",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIAN ASST. LICENSE",
"identifier": "PA19107",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.