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 1:4678 KELLYKRIS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-3411
Mailing Address - Country:US
Mailing Address - Phone:314-877-9198
Mailing Address - Fax:
Practice Address - Street 1:510 BAXTER RD STE 8
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-7032
Practice Address - Country:US
Practice Address - Phone:314-886-4510
Practice Address - Fax:314-866-4511
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025002507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily