Provider Demographics
NPI:1245886274
Name:GOSSER, DUSTIN M (APRN)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:M
Last Name:GOSSER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-540-3387
Mailing Address - Fax:502-540-3393
Practice Address - Street 1:4423 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3235
Practice Address - Country:US
Practice Address - Phone:502-495-2400
Practice Address - Fax:502-495-6345
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3013489363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100621480Medicaid
KYK287250OtherMEDICARE