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NPI Code Detail

MEDICARE: KELLY GROSS RN

MEDICARE: KELLY GROSS RN
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
1363LA2100XAcute Care Nurse PractitionerSP016971PA

General Provider Information

NPI Number : 1487104568
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY GROSS RN
Provider Business Mailing Address
First Line : 51 N 39TH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19104-2640
Country : US
Telephone Number : 215-294-9456
Fax Number : 215-222-8646
Provider Business Practice Location Address
First Line : 51 N 39TH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19104-2640
Country : US
Telephone Number : 215-294-9456
Fax Number : 215-222-8646
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2016
Last Update Date : 02/09/2026

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Directions to “ KELLY GROSS RN” Practice Location

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