MEDICARE: LAURA ELIZABETH GROSS FNP

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	363L00000X	Nurse Practitioner	2020002810	MO
2	363LF0000X	Family Nurse Practitioner	2020002810	MO

General Provider Information

NPI Number	:	1659902583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ELIZABETH GROSS FNP

Provider Business Mailing Address
First Line	:	314 S OHIO ST
Second Line	:
City	:	KING CITY
State	:	MO
Zip	:	64463-9531
Country	:	US
Telephone Number	:	816-341-6512
Fax Number	:

Provider Business Practice Location Address
First Line	:	5506 CORPORATE DR STE 1600
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64507-7765
Country	:	US
Telephone Number	:	816-271-7848
Fax Number	:

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

Provider Enumeration Date	:	01/29/2020
Last Update Date	:	07/23/2024

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