Provider Demographics
NPI:1134406531
Name:GILBERT, CRYSTAL S (APRN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:S
Last Name:GILBERT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4168
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40604-4168
Mailing Address - Country:US
Mailing Address - Phone:502-223-5811
Mailing Address - Fax:502-227-7379
Practice Address - Street 1:1080 GLENSBORO RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-9033
Practice Address - Country:US
Practice Address - Phone:502-839-4091
Practice Address - Fax:502-839-9650
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3007220363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3007220OtherLICENSE