Provider Demographics
NPI:1366213241
Name:CROSSETT, VICTORIA (DNP)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:CROSSETT
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:RAPHAEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2607 S 15TH PL
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8403
Mailing Address - Country:US
Mailing Address - Phone:479-366-7510
Mailing Address - Fax:
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-983-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024000885363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics