Provider Demographics
NPI:1922750785
Name:RODDY, CHRISTINA (NP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:RODDY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:KAY
Other - Last Name:FRYMIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 CROSSROADS PL STE 140
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6545
Mailing Address - Country:US
Mailing Address - Phone:618-244-8100
Mailing Address - Fax:618-244-3395
Practice Address - Street 1:403 EAST 5TH ST.
Practice Address - Street 2:
Practice Address - City:NORRIS CITY
Practice Address - State:IL
Practice Address - Zip Code:62869
Practice Address - Country:US
Practice Address - Phone:618-313-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024304363LF0000X, 363L00000X
IL209024304363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily