Provider Demographics
NPI:1659902583
Name:GROSS, LAURA ELIZABETH (FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:GROSS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S OHIO ST
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64463-9531
Mailing Address - Country:US
Mailing Address - Phone:816-341-6512
Mailing Address - Fax:
Practice Address - Street 1:5506 CORPORATE DR STE 1600
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-7765
Practice Address - Country:US
Practice Address - Phone:816-271-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020002810363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner