Provider Demographics
NPI:1699090514
Name:DOOLIN, CHRISTOPHER TODD (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:TODD
Last Name:DOOLIN
Suffix:
Gender:M
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 1:542 STEVE DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-4601
Mailing Address - Country:US
Mailing Address - Phone:702-858-3636
Mailing Address - Fax:270-858-3660
Practice Address - Street 1:542 STEVE DR
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-4601
Practice Address - Country:US
Practice Address - Phone:270-858-3636
Practice Address - Fax:270-858-3660
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-03
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006418363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100200620Medicaid