Provider Demographics
NPI:1992944607
Name:GROSS, KASEY DAWN (CRNP)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:DAWN
Last Name:GROSS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:DAWN
Other - Last Name:GROSS VICKERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:425 5TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ATTALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35954-2214
Mailing Address - Country:US
Mailing Address - Phone:256-492-7800
Mailing Address - Fax:256-494-5511
Practice Address - Street 1:425 5TH AVE NW
Practice Address - Street 2:
Practice Address - City:ATTALLA
Practice Address - State:AL
Practice Address - Zip Code:35954-2214
Practice Address - Country:US
Practice Address - Phone:256-492-7800
Practice Address - Fax:256-494-5536
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-091953363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily