Provider Demographics
NPI:1316403561
Name:GESSERT-HERRING, KRYSTAL MARIE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:MARIE
Last Name:GESSERT-HERRING
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12418 DOVE MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-0048
Mailing Address - Country:US
Mailing Address - Phone:704-712-4032
Mailing Address - Fax:
Practice Address - Street 1:2391 COURT DR STE 110
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2197
Practice Address - Country:US
Practice Address - Phone:704-853-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011462363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner