Provider Demographics
NPI:1932095353
Name:UNDERWOOD, CHRISTINA ANN
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANN
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISSY
Other - Middle Name:ANN
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2706 HIGHWAY 75
Mailing Address - Street 2:
Mailing Address - City:WETUMKA
Mailing Address - State:OK
Mailing Address - Zip Code:74883
Mailing Address - Country:US
Mailing Address - Phone:405-584-0961
Mailing Address - Fax:
Practice Address - Street 1:1011 HONOR HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-1318
Practice Address - Country:US
Practice Address - Phone:918-616-5064
Practice Address - Fax:918-577-4808
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0113528163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management