MEDICARE: GRACE GOSSERAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		LA

General Provider Information

NPI Number	:	1407780174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE GOSSERAND

Provider Business Mailing Address
First Line	:	14332 PATIN DYKE RD
Second Line	:
City	:	VENTRESS
State	:	LA
Zip	:	70783-4100
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3330 MASONIC DR
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3841
Country	:	US
Telephone Number	:	318-487-1122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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Directions to “ GRACE GOSSERAND ” Practice Location

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