Healthcare Provider Details

I. General information

NPI: 1710406962
Provider Name (Legal Business Name): CHRISTA K HOLMON APN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTA R DYSON-SPILLER APN, NP-C

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 STATE ST
EAST SAINT LOUIS IL
62205-1356
US

IV. Provider business mailing address

4901 STATE ST
EAST SAINT LOUIS IL
62205-1356
US

V. Phone/Fax

Practice location:
  • Phone: 618-482-4562
  • Fax: 618-482-4575
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209016426
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: