Provider Demographics
NPI:1962168120
Name:THAXTON, CHRISTIE FITZGERALD (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:FITZGERALD
Last Name:THAXTON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 EDEN WAY N STE 118
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2776
Mailing Address - Country:US
Mailing Address - Phone:434-203-9097
Mailing Address - Fax:757-937-6148
Practice Address - Street 1:1021 EDEN WAY N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2776
Practice Address - Country:US
Practice Address - Phone:434-203-9097
Practice Address - Fax:757-937-6148
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001217785163WC0400X
171W00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No171W00000XOther Service ProvidersContractor