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General NPI Number Information
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NPI Number | 1164703153
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Entity Type | Individual
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Provider Name | CHARLES CHRISTOPHER GOSSMAN APRN
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Gender | Male
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Dates
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Enumeration Date | 09/02/2011
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Last Update Date | 10/03/2015
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Provider Practice Location Address
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Address Line | 6055 N MAIN STREET RD
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City | WEBB CITY
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State | MO
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Zip | 64870-7219
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Country | US
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Telephone | 417-206-0900
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Fax | 417-206-0907
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Provider Business Mailing Address
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Address Line | 6055 N MAIN STREET RD
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City | WEBB CITY
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State | MO
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Zip | 64870-7219
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Country | US
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Telephone | 417-206-0900
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Fax | 417-206-0907
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 52-75482-121
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2014008349
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License Number State | MO
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