Provider Demographics
NPI:1982346045
Name:COFFEY, CRISTY (CNP)
Entity type:Individual
Prefix:
First Name:CRISTY
Middle Name:
Last Name:COFFEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:CRISTY
Other - Middle Name:GWYNN
Other - Last Name:ROACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:331 SPORTSPLEX DR STE C
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-5350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:331 SPORTSPLEX DR STE C
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-5350
Practice Address - Country:US
Practice Address - Phone:512-894-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1074477363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty