Provider Demographics
NPI:1548665607
Name:PIPKENS, CRYSTAL L (ANP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:L
Last Name:PIPKENS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 959354
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-9354
Mailing Address - Country:US
Mailing Address - Phone:636-916-7272
Mailing Address - Fax:636-916-7274
Practice Address - Street 1:10 HOSPITAL DR STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1659
Practice Address - Country:US
Practice Address - Phone:636-916-7272
Practice Address - Fax:636-916-7274
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014036835363L00000X, 363LF0000X
MO2011005736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner