Provider Demographics
NPI:1275988347
Name:GAUSE, LIA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:LIA
Middle Name:MARIE
Last Name:GAUSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LIA
Other - Middle Name:MARIE
Other - Last Name:GROGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 219672
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64121-9672
Mailing Address - Country:US
Mailing Address - Phone:816-781-6066
Mailing Address - Fax:
Practice Address - Street 1:2521 GLENN HENDREN DR STE 204
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3388
Practice Address - Country:US
Practice Address - Phone:816-781-6066
Practice Address - Fax:816-792-5130
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical