Healthcare Provider Details

I. General information

NPI: 1548665607
Provider Name (Legal Business Name): CRYSTAL L PIPKENS ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL CHAN

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HOSPITAL DR STE 100
SAINT PETERS MO
63376-1659
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 636-916-7272
  • Fax: 636-916-7274
Mailing address:
  • Phone: 636-916-7272
  • Fax: 636-916-7274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2014036835
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2011005736
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014036835
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: