Provider Demographics
NPI:1487361416
Name:GANNON, CHRISTIE (FNP-C)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:GANNON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 DUBLIN DR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-7860
Mailing Address - Country:US
Mailing Address - Phone:316-251-2531
Mailing Address - Fax:
Practice Address - Street 1:700 W CENTRAL AVE STE 200
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2187
Practice Address - Country:US
Practice Address - Phone:316-320-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS81524363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily