Healthcare Provider Details

I. General information

NPI: 1487309571
Provider Name (Legal Business Name): CHRISTINA ANH BROYLES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA TRAN FNP

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 US HIGHWAY 61
FESTUS MO
63028-4100
US

IV. Provider business mailing address

1400 US HIGHWAY 61
FESTUS MO
63028-4100
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6299
  • Fax: 314-251-4450
Mailing address:
  • Phone: 314-251-6299
  • Fax: 314-251-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2021029968
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: