Provider Demographics
NPI:1053349175
Name:FAULKNER, CHRISTINA ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:ANNE
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2587
Mailing Address - Country:US
Mailing Address - Phone:620-343-2900
Mailing Address - Fax:
Practice Address - Street 1:1301 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2587
Practice Address - Country:US
Practice Address - Phone:620-343-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-33107207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200568050AMedicaid
KS068002016OtherMEDICARE PTAN