Healthcare Provider Details

I. General information

NPI: 1750791331
Provider Name (Legal Business Name): KRISTINE GONZALEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3937 VOGEL RD
ARNOLD MO
63010-3798
US

IV. Provider business mailing address

PO BOX 955534
SAINT LOUIS MO
63195-6203
US

V. Phone/Fax

Practice location:
  • Phone: 844-776-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014007844
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2014007844
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: