Healthcare Provider Details

I. General information

NPI: 1043361264
Provider Name (Legal Business Name): GAIL L CRAFT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 PINE DR
STE GENEVIEVE MO
63670-1456
US

IV. Provider business mailing address

PO BOX 366
STE GENEVIEVE MO
63670-0366
US

V. Phone/Fax

Practice location:
  • Phone: 573-883-4477
  • Fax: 573-883-4472
Mailing address:
  • Phone: 573-883-4477
  • Fax: 573-883-4472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number121032
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: