Provider Demographics
NPI:1427082023
Name:SCHULZ, CHRISTINE C (PA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:C
Last Name:SCHULZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:C
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1400 WALLACE BLVD
Mailing Address - Street 2:ATTN CREDENTIALING
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1708
Mailing Address - Country:US
Mailing Address - Phone:806-414-9559
Mailing Address - Fax:806-351-3765
Practice Address - Street 1:1400 S COULTER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1786
Practice Address - Country:US
Practice Address - Phone:806-414-9559
Practice Address - Fax:806-351-3765
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00807363A00000X
TX253545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111518004Medicaid
NM34571248Medicaid
OK200280810 AMedicaid
NM34571248Medicaid
R59526Medicare UPIN
TX80N054Medicare PIN