Provider Demographics
NPI:1063091387
Name:GAUT, CHRISTINA JEANETTE (FNP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JEANETTE
Last Name:GAUT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:JEANETTE
Other - Last Name:WITHEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 1ST CAPITOL DR STE 301
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2883
Mailing Address - Country:US
Mailing Address - Phone:636-669-3080
Mailing Address - Fax:
Practice Address - Street 1:400 1ST CAPITOL DR
Practice Address - Street 2:SUITE 301
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2883
Practice Address - Country:US
Practice Address - Phone:636-669-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOF10201252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily