Individual
TANNIKA CHRISTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1023 NEW MOODY LN, SUITE 201, LA GRANGE, KY 40031-9177
(502) 225-4480
(502) 225-9169
Mailing address
1023 NEW MOODY LN, SUITE 201, LA GRANGE, KY 40031-9177
(502) 225-4480
(502) 225-9169
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
41864
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3754512000
PASSPORT ADVANTAGE
KY
01
—
50026877
PASSPORT HEALTH PLAN
KY
05
—
7100093970
—
KY
05
—
D5341
—
UT
01
—
P00757041
MEDICARE RR
KY
Enumeration date
11/09/2006
Last updated
12/02/2020
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