Provider Demographics
NPI:1154134419
Name:GERVE, KANITRA (FNP-BC)
Entity type:Individual
Prefix:
First Name:KANITRA
Middle Name:
Last Name:GERVE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:884 WOODS MILL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3657
Mailing Address - Country:US
Mailing Address - Phone:636-227-8226
Mailing Address - Fax:636-686-9194
Practice Address - Street 1:884 WOODS MILL RD STE 201
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-3657
Practice Address - Country:US
Practice Address - Phone:636-227-8226
Practice Address - Fax:636-686-9194
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025002507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily