Provider Demographics
NPI:1164703153
Name:GOSSMAN, CHARLES CHRISTOPHER (APRN)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:CHRISTOPHER
Last Name:GOSSMAN
Suffix:
Gender:M
Credentials:APRN
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Mailing Address - Street 1:6055 N MAIN STREET RD
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-7219
Mailing Address - Country:US
Mailing Address - Phone:417-206-0900
Mailing Address - Fax:417-206-0907
Practice Address - Street 1:6055 N MAIN STREET RD
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-7219
Practice Address - Country:US
Practice Address - Phone:417-206-0900
Practice Address - Fax:417-206-0907
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2015-10-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS52-75482-121363LF0000X
MO2014008349363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily