Provider Demographics
NPI:1801109350
Name:GROSS, TAMMY MICHELLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:MICHELLE
Last Name:GROSS
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:1010 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:MC KEE
Mailing Address - State:KY
Mailing Address - Zip Code:40447-7089
Mailing Address - Country:US
Mailing Address - Phone:859-626-7700
Mailing Address - Fax:859-626-7890
Practice Address - Street 1:30 STACY LANE RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-7356
Practice Address - Country:US
Practice Address - Phone:606-723-0665
Practice Address - Fax:606-723-0680
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2014-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3006534363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100134760Medicaid
KYP400039548OtherMEDICARE PTAN