Provider Demographics
NPI:1740468388
Name:GROSSERODE, TAMMY JEAN (PA-C)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:JEAN
Last Name:GROSSERODE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:5810 NW BARRY RD
Mailing Address - Street 2:STE 100
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-1400
Mailing Address - Country:US
Mailing Address - Phone:816-454-0666
Mailing Address - Fax:816-454-1694
Practice Address - Street 1:5330 N OAK TRFY
Practice Address - Street 2:SUITE 200
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4699
Practice Address - Country:US
Practice Address - Phone:816-454-0666
Practice Address - Fax:816-454-1694
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2019-07-16
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Provider Licenses
StateLicense IDTaxonomies
MO2006024407363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant