Provider Demographics
NPI:1922735554
Name:DURBIN, CHRISTA JANE
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:JANE
Last Name:DURBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 GRAVOIS BLUFFS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7758
Mailing Address - Country:US
Mailing Address - Phone:636-343-5223
Mailing Address - Fax:636-343-5345
Practice Address - Street 1:774 GRAVOIS BLUFFS BLVD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7716
Practice Address - Country:US
Practice Address - Phone:636-343-5223
Practice Address - Fax:636-343-5345
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012023622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF07220223OtherAANP CERTIFICATION NUMBER