MEDICARE: KANITRA GERVE FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2025002507	MO

General Provider Information

NPI Number	:	1154134419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANITRA GERVE FNP-BC

Provider Business Mailing Address
First Line	:	4678 KELLYKRIS DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63304-3411
Country	:	US
Telephone Number	:	314-877-9198
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 BAXTER RD STE 8
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-7032
Country	:	US
Telephone Number	:	314-886-4510
Fax Number	:	314-886-4511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2025
Last Update Date	:	06/04/2026

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