Basic Information
| Provider Information | |||||||||
| NPI: | 1538162797 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAST | ||||||||
| FirstName: | KRISTIE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8500 S 36TH TER | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729088880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4796481800 | ||||||||
| FaxNumber: | 4794345899 | ||||||||
| Practice Location | |||||||||
| Address1: | 8901 CARTI WAY | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722056523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019063000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 01/19/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/15/2006 | ||||||||
| NPIReactivationDate: | 03/21/2006 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | E1533 | AR | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 100194810A | 05 | OK | MEDICAID | 5K602 | 01 | AR | BCBS | OTHER | 3557036001 | 01 | AR | CIGNA | OTHER | 020156300 | 01 | AR | BLACK LUNG | OTHER | 5398655 | 01 | AR | AETNA | OTHER | 920004894 | 01 | RAILROAD MEDICARE | OTHER | 17644000000 | 01 | AR | QUAL CHOICE | OTHER | 710694232 | 01 | AR | TRICARE | OTHER | 132774001 | 05 | AR | MEDICAID |