Provider Demographics
NPI:1437133535
Name:FENNELL, CHRISTOPHER FRANCIS (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:FRANCIS
Last Name:FENNELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3450
Mailing Address - Street 2:REGIONAL BEHAVIORAL HEALTH CENTER
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-3450
Mailing Address - Country:US
Mailing Address - Phone:605-719-7200
Mailing Address - Fax:605-719-7680
Practice Address - Street 1:910 KENTON STATION DR
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-9613
Practice Address - Country:US
Practice Address - Phone:606-759-0490
Practice Address - Fax:606-759-0499
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-0077732084P0800X
KY033722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100210560Medicaid
KY03372OtherMEDICAL LICENSE
KYK041011OtherMEDICARE