Provider Demographics
NPI:1518170596
Name:GROSS, KAREN M (ANP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:GROSS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:TOUSSAINT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 PATIENTS FIRST DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4700
Mailing Address - Country:US
Mailing Address - Phone:636-239-7500
Mailing Address - Fax:636-239-2836
Practice Address - Street 1:901 PATIENTS FIRST DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4700
Practice Address - Country:US
Practice Address - Phone:636-239-7500
Practice Address - Fax:636-239-2836
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100677363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1518170596Medicaid
MOP01276122OtherRAILROAD MEDICARE
MO429906803Medicaid
MOP01134618OtherRAILROAD MEDICARE
MO152800178Medicare PIN
MO152810027Medicare PIN
MOP01134618OtherRAILROAD MEDICARE
MO1518170596Medicaid