Provider Demographics
NPI:1972934982
Name:HUBER, KRISTA (FNP)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:HUBER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2472 HIGHWAY A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-6417
Mailing Address - Country:US
Mailing Address - Phone:636-239-4834
Mailing Address - Fax:
Practice Address - Street 1:708 E HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65066-1588
Practice Address - Country:US
Practice Address - Phone:573-437-4481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013040390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily