Healthcare Provider Details

I. General information

NPI: 1154806958
Provider Name (Legal Business Name): KRISTINA A. GABBARD APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA A. STONE

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W MADISON AVE
CHRISMAN IL
61924-1118
US

IV. Provider business mailing address

727 E COURT ST
PARIS IL
61944-2460
US

V. Phone/Fax

Practice location:
  • Phone: 217-269-2394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.017745
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: