Provider Demographics
NPI:1881132496
Name:GROSE, TAMARA HARPER (APRN)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:HARPER
Last Name:GROSE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:N
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2420 N WOODLAWN BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-3960
Mailing Address - Country:US
Mailing Address - Phone:316-347-7157
Mailing Address - Fax:
Practice Address - Street 1:2420 N WOODLAWN BLVD STE 300
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-3960
Practice Address - Country:US
Practice Address - Phone:316-347-7157
Practice Address - Fax:316-247-9528
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS129512163W00000X
KS53-82417-092363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse