Provider Demographics
NPI:1619501483
Name:GUBERNATH, KRYSTEL MARIE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTEL
Middle Name:MARIE
Last Name:GUBERNATH
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 8TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-6818
Mailing Address - Country:US
Mailing Address - Phone:040-761-9986
Mailing Address - Fax:
Practice Address - Street 1:909 8TH ST STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-6818
Practice Address - Country:US
Practice Address - Phone:940-761-9986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX349980164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse