Provider Demographics
NPI:1053858589
Name:GILB, KRYSTAL (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:
Last Name:GILB
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 270419
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-0419
Mailing Address - Country:US
Mailing Address - Phone:314-366-4874
Mailing Address - Fax:314-366-4875
Practice Address - Street 1:10296 BIG BEND RD STE 206
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-6582
Practice Address - Country:US
Practice Address - Phone:314-366-4874
Practice Address - Fax:314-366-4875
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015697363L00000X
MO2016039172363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner