Provider Demographics
NPI:1477008753
Name:AUGUST, KRYSTAL (FNP-C)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:AUGUST
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:
Other - Last Name:BEECHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3231 S NATIONAL AVE STE 440
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7304
Mailing Address - Country:US
Mailing Address - Phone:636-266-7946
Mailing Address - Fax:314-364-6381
Practice Address - Street 1:3231 S NATIONAL AVE STE 440
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7304
Practice Address - Country:US
Practice Address - Phone:636-266-7946
Practice Address - Fax:314-364-6381
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016029749363LF0000X, 363LF0000X
MO2013028142163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA2082586Medicare PIN