Provider Demographics
NPI:1215065073
Name:GROS, ANDRE GERVAIS (NP)
Entity type:Individual
Prefix:MRS
First Name:ANDRE
Middle Name:GERVAIS
Last Name:GROS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 BELANGER STREET
Mailing Address - Street 2:STE 102
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360
Mailing Address - Country:US
Mailing Address - Phone:985-873-0112
Mailing Address - Fax:
Practice Address - Street 1:855 BELANGER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4463
Practice Address - Country:US
Practice Address - Phone:985-873-0112
Practice Address - Fax:985-857-8624
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO3855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1109983Medicaid
LA4B996Medicare ID - Type Unspecified
LA1109983Medicaid