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General NPI Number Information
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NPI Number | 1164970364
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Entity Type | Individual
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Provider Name | BRYAN JOHN GOSS ACNP
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Gender | Male
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Dates
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Enumeration Date | 09/15/2016
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 12303 DEPAUL DR
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City | BRIDGETON
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State | MO
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Zip | 63044-2512
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Country | US
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Telephone | 314-344-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 12303 DEPAUL DR
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City | BRIDGETON
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State | MO
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Zip | 63044-2512
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Country | US
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Telephone | 314-344-6000
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Fax |
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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 | 364SE0003X
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Taxonomy Name | Emergency Clinical Nurse Specialist
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License Number | 107699
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License Number State | WV
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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 | 107699
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 107699
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License Number State | WV
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9374626
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2025039856
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License Number State | MO
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