Provider Demographics
NPI:1700243730
Name:TABLER GRESHAM, KRISTA L (NP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:L
Last Name:TABLER GRESHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:GRESHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:111 EAST SHEPARD AVENUE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-0315
Mailing Address - Country:US
Mailing Address - Phone:936-632-2777
Mailing Address - Fax:936-632-5819
Practice Address - Street 1:111 E SHEPHERD AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-0315
Practice Address - Country:US
Practice Address - Phone:936-632-2777
Practice Address - Fax:936-632-5819
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127019363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily