Provider Demographics
NPI:1104349950
Name:GROSS, KRISTINA (NP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:GROSS
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:DYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:810 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-3634
Mailing Address - Country:US
Mailing Address - Phone:985-515-7884
Mailing Address - Fax:985-304-0081
Practice Address - Street 1:810 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-3634
Practice Address - Country:US
Practice Address - Phone:985-289-7139
Practice Address - Fax:985-289-1640
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN133632163W00000X
LAAP09507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse