Provider Demographics
NPI:1295751592
Name:GILSTRAP, EVANGELA BERNICE (FNP)
Entity type:Individual
Prefix:MS
First Name:EVANGELA
Middle Name:BERNICE
Last Name:GILSTRAP
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:EVE
Other - Middle Name:
Other - Last Name:GILSTRAP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:419 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1818
Mailing Address - Country:US
Mailing Address - Phone:314-362-4819
Mailing Address - Fax:314-362-7086
Practice Address - Street 1:419 CLARK AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-1818
Practice Address - Country:US
Practice Address - Phone:314-805-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004459363LF0000X
MO068132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425738119Medicaid
ILENROLLEDMedicaid
MO818970183Medicaid
MO818970183Medicare PIN