Kyle Gross
Nurse Practitioner - Gerontology
3 Richland Medical Park Dr Ste 510
Columbia
, South Carolina 29203-6854
Kyle Gross
Nurse Practitioner - Gerontology
3 Richland Medical Park Dr Ste 510
Columbia
, South Carolina 29203-6854
(803) 296-7330
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About
Features
Specialties
- Nurse Practitioner - Gerontology
Languages spoken
- English
Location
First Address
- Kyle Gross
- Po Box 743904
- Atlanta, GA
- Zip : 30374-3904
- Fax : (803) 296-7330
- Phone : (803) 296-7320
Second Address
- Kyle Gross
- 3 Richland Medical Park Dr Ste 510
- Columbia, SC
- Zip : 29203-6854
- Phone : (803) 360-6099
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LG0600X | Nurse Practitioner - Gerontology | 21917 | SC |
National Provider Identifier
| NPI | 1033697362 |
|---|---|
| Provider Name | Kyle Gross |
| First Address | Atlanta, GA 30374-3904 |
| Second Address | Columbia, SC 29203-6854 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 30/07/2018 |
| Last Update Date | 19/03/2019 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| NP5554 | (05) | SC |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.