Healthcare Provider Details

I. General information

NPI: 1134406531
Provider Name (Legal Business Name): CRYSTAL S GILBERT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 GLENSBORO RD
LAWRENCEBURG KY
40342-9033
US

IV. Provider business mailing address

PO BOX 4168
FRANKFORT KY
40604-4168
US

V. Phone/Fax

Practice location:
  • Phone: 502-839-4091
  • Fax: 502-839-9650
Mailing address:
  • Phone: 502-223-5811
  • Fax: 502-227-7379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3007220
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: