Provider Demographics
NPI:1306923529
Name:RIVEST, CHRISTINE L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:L
Last Name:RIVEST
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:209 COLLEGE STREET
Mailing Address - Street 2:ALPHA MEDICAL ASSOCIATES
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083
Mailing Address - Country:US
Mailing Address - Phone:615-666-2056
Mailing Address - Fax:615-666-3022
Practice Address - Street 1:1124 HWY 52 EAST STE 3
Practice Address - Street 2:ALPHA MEDICAL ASSOCIATES
Practice Address - City:WESTMORELAND
Practice Address - State:TN
Practice Address - Zip Code:37186
Practice Address - Country:US
Practice Address - Phone:615-644-4203
Practice Address - Fax:615-644-4228
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601003272363AM0700X
TNPA01473363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI594140Medicare UPIN