Provider Demographics
NPI:1396052056
Name:WILSON-EGGBURN, CHRISTY MICHELLE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:MICHELLE
Last Name:WILSON-EGGBURN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N BLAKE ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71601-3226
Mailing Address - Country:US
Mailing Address - Phone:870-536-6600
Mailing Address - Fax:
Practice Address - Street 1:209 N BLAKE ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-3226
Practice Address - Country:US
Practice Address - Phone:870-536-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03410 APN363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily