Healthcare Provider Details

I. General information

NPI: 1104349950
Provider Name (Legal Business Name): KRISTINA GROSS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA DYE

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 RIVERSIDE DR
FRANKLINTON LA
70438-3634
US

IV. Provider business mailing address

810 RIVERSIDE DR
FRANKLINTON LA
70438-3634
US

V. Phone/Fax

Practice location:
  • Phone: 985-289-7139
  • Fax: 985-289-1640
Mailing address:
  • Phone: 985-515-7884
  • Fax: 985-304-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN133632
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09507
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: