Provider Demographics
NPI:1992360796
Name:FORD, CHRISTAL (BSN RN-BC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTAL
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:BSN RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10854 CHICKASHA DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-7924
Mailing Address - Country:US
Mailing Address - Phone:601-832-0832
Mailing Address - Fax:
Practice Address - Street 1:10854 CHICKASHA DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-7924
Practice Address - Country:US
Practice Address - Phone:601-832-0832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2020013151163WC0400X
TX917808163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management