Provider Demographics
NPI:1841746195
Name:GROSS, DJ (APRN)
Entity Type:Individual
Prefix:
First Name:DJ
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1100
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1100
Mailing Address - Country:US
Mailing Address - Phone:417-256-9111
Mailing Address - Fax:417-257-5838
Practice Address - Street 1:1115 ALASKA ST
Practice Address - Street 2:SUITE 215
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2061
Practice Address - Country:US
Practice Address - Phone:417-257-5989
Practice Address - Fax:417-256-1780
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2016023382363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily