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General NPI Number Information
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NPI Number | 1992905780
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Entity Type | Organization
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Legal Business Name | KAYE M. GROSSNICKLE, LLC
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 809 CENTRAL AVE SUITE 420
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City | FORT DODGE
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State | IA
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Zip | 50501-3936
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Country | US
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Telephone | 515-955-1836
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Fax | 515-955-7115
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Provider Business Mailing Address
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Address Line | PO BOX 261
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City | FORT DODGE
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State | IA
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Zip | 50501-0261
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Country | US
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Telephone | 515-955-1836
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Fax | 515-955-7115
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. KAYE GROSSNICKLE
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Credential | ARNP
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Telephone | 515-955-1836
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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 | A063458
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License Number State | IA
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