Provider Demographics
NPI:1104255629
Name:GASS, ANNA V (APRN)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:V
Last Name:GASS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:B
Other - Last Name:VISSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 950244
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0244
Mailing Address - Country:US
Mailing Address - Phone:502-774-8631
Mailing Address - Fax:502-772-8189
Practice Address - Street 1:529 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3229
Practice Address - Country:US
Practice Address - Phone:502-561-7220
Practice Address - Fax:502-588-9529
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008327363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100270100Medicaid
KYK094915Medicare PIN
KYK094910Medicare PIN
KY7100270100Medicaid
KYK094913Medicare PIN
KYK094912Medicare PIN
KYK094914Medicare PIN
KYK094916Medicare PIN