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General NPI Number Information
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NPI Number | 1700243730
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Entity Type | Individual
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Provider Name | KRISTA L TABLER GRESHAM NP
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Gender | Female
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Dates
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Enumeration Date | 01/21/2016
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Last Update Date | 03/17/2026
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Provider Practice Location Address
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Address Line | 525 N BRENTWOOD
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City | LUFKIN
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State | TX
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Zip | 75904-7124
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Country | US
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Telephone | 936-205-2778
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Fax | 936-873-8753
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Provider Business Mailing Address
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Address Line | 525 N BRENTWOOD
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City | LUFKIN
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State | TX
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Zip | 75904-7124
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Country | US
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Telephone | 936-205-2778
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Fax | 936-873-8753
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP127019
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License Number State | TX
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