MEDICARE: MRS. KRYSTAL MARIE GESSERT-HERRING NP-C

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	363L00000X	Nurse Practitioner	5011462	NC

General Provider Information

NPI Number	:	1316403561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRYSTAL MARIE GESSERT-HERRING NP-C

Provider Business Mailing Address
First Line	:	12418 DOVE MEADOW DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-0048
Country	:	US
Telephone Number	:	704-712-4032
Fax Number	:

Provider Business Practice Location Address
First Line	:	2391 COURT DR STE 110
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-2197
Country	:	US
Telephone Number	:	704-853-3330
Fax Number	:

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

Provider Enumeration Date	:	02/13/2019
Last Update Date	:	02/13/2019

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