Provider Demographics
NPI:1215110945
Name:GRAYSON, CHRISTINA M (PA-C, MPH)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10635 PROFESSIONAL CIR
Mailing Address - Street 2:STE A
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5849
Mailing Address - Country:US
Mailing Address - Phone:775-852-0505
Mailing Address - Fax:775-852-0508
Practice Address - Street 1:10635 PROFESSIONAL CIR
Practice Address - Street 2:STE A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5849
Practice Address - Country:US
Practice Address - Phone:775-852-0505
Practice Address - Fax:775-852-0508
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1282363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1215110945Medicaid
12432339OtherCAQH
NVFE494XMedicare PIN
NV1215110945Medicaid
NVV105788Medicare PIN