Provider Demographics
NPI:1396193264
Name:BLOCKER, CHRISTY I
Entity type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:
Last Name:BLOCKER
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 DONNA ST
Mailing Address - Street 2:
Mailing Address - City:LEPANTO
Mailing Address - State:AR
Mailing Address - Zip Code:72354-2420
Mailing Address - Country:US
Mailing Address - Phone:870-483-0068
Mailing Address - Fax:870-483-0066
Practice Address - Street 1:809 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472-2611
Practice Address - Country:US
Practice Address - Phone:870-483-0068
Practice Address - Fax:870-483-0066
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator