Provider Demographics
NPI:1851592604
Name:GABLE, KRISTINE (MSN, RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:GABLE
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 MERRYCREST DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-8115
Mailing Address - Country:US
Mailing Address - Phone:901-619-7809
Mailing Address - Fax:
Practice Address - Street 1:1223 MERRYCREST DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-8115
Practice Address - Country:US
Practice Address - Phone:901-619-7809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03527304Medicaid
LA1355127Medicaid
KY7100073720Medicaid
AL1851592604Medicaid
AR177189758Medicaid
TN1507634Medicaid
KY7100073720Medicaid