Provider Demographics
NPI:1437313335
Name:GAMMON, GRACE C (ARNP)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:C
Last Name:GAMMON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-502-7000
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:9400 E 350
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-6509
Practice Address - Country:US
Practice Address - Phone:816-251-5700
Practice Address - Fax:816-251-5701
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO091419363LF0000X
KS53-75377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO091419OtherLICENSE
MOX93000044Medicare PIN
MO091419OtherLICENSE