Provider Demographics
NPI: | 1386047249 |
---|---|
Name: | BIRT, CHRISTOPHER R (APRN) |
Entity type: | Individual |
Prefix: | |
First Name: | CHRISTOPHER |
Middle Name: | R |
Last Name: | BIRT |
Suffix: | |
Gender: | M |
Credentials: | APRN |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 3841 GREEN HILLS VILLAGE DR STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | NASHVILLE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37215-2691 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3601 THE VANDERBILT CLINIC |
Practice Address - Street 2: | |
Practice Address - City: | NASHVILLE |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37232-2861 |
Practice Address - Country: | US |
Practice Address - Phone: | 615-322-3000 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2014-10-06 |
Last Update Date: | 2024-10-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 19204 | 363LA2100X, 363LG0600X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LG0600X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 7100410720 | Medicaid | |
KY | 7100410720 | Medicaid |