Provider Demographics
NPI:1699215731
Name:GROSS, CHRISTOPHER (FNP)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:GROSS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 HORIZAN RD STE 4
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-2926
Mailing Address - Country:US
Mailing Address - Phone:870-732-0332
Mailing Address - Fax:870-732-3078
Practice Address - Street 1:2201 HORIZAN RD STE 4
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-2926
Practice Address - Country:US
Practice Address - Phone:870-732-0332
Practice Address - Fax:870-732-3078
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005053363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily