MEDICARE: KRYSTLE GROSECLOSE

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	2085B0100X	Body Imaging Physician	1685	NV

General Provider Information

NPI Number	:	1881526333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTLE GROSECLOSE

Provider Business Mailing Address
First Line	:	10200 DELRAY BEACH AVE UNIT 203
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-1014
Country	:	US
Telephone Number	:	702-785-7278
Fax Number	:

Provider Business Practice Location Address
First Line	:	10040 ALTA DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-8613
Country	:	US
Telephone Number	:	702-732-6000
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ KRYSTLE GROSECLOSE ” Practice Location

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