Healthcare Provider Details

I. General information

NPI: 1104255629
Provider Name (Legal Business Name): ANNA V GASS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA B VISSMAN APRN

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 S JACKSON ST
LOUISVILLE KY
40202-3229
US

IV. Provider business mailing address

PO BOX 950244
LOUISVILLE KY
40295-0244
US

V. Phone/Fax

Practice location:
  • Phone: 502-561-7220
  • Fax: 502-588-9529
Mailing address:
  • Phone: 502-774-8631
  • Fax: 502-772-8189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008327
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: