Healthcare Provider Details

I. General information

NPI: 1548939192
Provider Name (Legal Business Name): CHRISTINA RENEE ROYBAL FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 HIGHWAY K CLINIC 6477
O FALLON MO
63368-8675
US

IV. Provider business mailing address

8 BEAUMOUNT CT
O FALLON MO
63366-7519
US

V. Phone/Fax

Practice location:
  • Phone: 636-272-5856
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018003491
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2018003491
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: