Provider Demographics
NPI:1538162797
Name:GAST, KRISTIE L (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:L
Last Name:GAST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0146
Mailing Address - Country:US
Mailing Address - Phone:360-683-9895
Mailing Address - Fax:360-582-5614
Practice Address - Street 1:1100 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2029
Practice Address - Country:US
Practice Address - Phone:417-256-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2025-02-20
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
WAMD614735102085R0001X
MO20230419722085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5398655OtherAETNA
AR17644000000OtherQUAL CHOICE
AR3557036001OtherCIGNA
AR020156300OtherBLACK LUNG
OK100194810AMedicaid
AR132774001Medicaid
AR5K602OtherBCBS
AR710694232OtherTRICARE
920004894OtherRAILROAD MEDICARE
AR5K602OtherBCBS
ARF43962Medicare UPIN