Provider Demographics
NPI:1073514667
Name:CAMPBELL, CHRISTI A (FNP,PHD)
Entity type:Individual
Prefix:
First Name:CHRISTI
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:FNP,PHD
Other - Prefix:
Other - First Name:CHRISTI
Other - Middle Name:
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 170607
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-0032
Mailing Address - Country:US
Mailing Address - Phone:512-250-9140
Mailing Address - Fax:512-250-2207
Practice Address - Street 1:11110 TOM ADAMS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-3354
Practice Address - Country:US
Practice Address - Phone:512-250-9140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX521075363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177450702Medicaid
TX8Y5079OtherBLUE CROSS BLUE SHIELD
TX8F4601Medicare PIN
TX8F4601Medicare PIN