Individual
CHRISTY TUCKER BRACKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
MEDICAL CENTER BLVD, EMERGENCY DEPARTMENT, WINSTON SALEM, NC 27157-0001
(336) 716-8740
(336) 716-0345
Mailing address
DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-1089
(336) 716-8740
(336) 716-0345
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
104021
NC
363AM0700X
Medical Physician Assistant
104021
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202781
MEDCOST
—
Enumeration date
06/09/2006
Last updated
07/02/2013
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