Healthcare Provider Details

I. General information

NPI: 1467971804
Provider Name (Legal Business Name): KRISTEN WILBER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN FISCHER

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 OLD DES PERES RD
SAINT LOUIS MO
63131-1865
US

IV. Provider business mailing address

1010 OLD DES PERES RD
DES PERES MO
63131-1865
US

V. Phone/Fax

Practice location:
  • Phone: 314-729-0077
  • Fax:
Mailing address:
  • Phone: 314-729-0077
  • Fax: 314-729-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016008742
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: