Provider Demographics
NPI:1922690254
Name:CALVERT, GAIL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:CALVERT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 W LOCKLING ST
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:64628-2003
Mailing Address - Country:US
Mailing Address - Phone:660-268-4006
Mailing Address - Fax:660-258-9006
Practice Address - Street 1:624 W LOCKLING ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:MO
Practice Address - Zip Code:64628-2003
Practice Address - Country:US
Practice Address - Phone:660-268-4006
Practice Address - Fax:660-258-9006
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021006275363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner