Basic Information
| Provider Information | |||||||||
| NPI: | 1629222070 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILBERT | ||||||||
| FirstName: | KRISTINA | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022725754 | ||||||||
| FaxNumber: | 5022725339 | ||||||||
| Practice Location | |||||||||
| Address1: | 1230 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | LA GRANGE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400317986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022256900 | ||||||||
| FaxNumber: | 5026667693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2008 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3005971 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 200961820 | 05 | IN | MEDICAID | 50042936 | 01 | KY | PASSPORT | OTHER | 7100073510 | 05 | KY | MEDICAID | 000000787146 | 01 | KY | ANTHEM BC/BS | OTHER |