Individual
KELLEY LOU GOSSAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
3860 MONROE RD, DE PERE, WI 54115-8399
(920) 496-4700
(920) 496-4705
Mailing address
PO BOX 19070, PREVEA HEALTH, GREEN BAY, WI 54307-9070
(920) 496-4700
(920) 496-4705
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
87057
WI
363L00000X
Nurse Practitioner
1259
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43971300
—
WI
Enumeration date
07/13/2006
Last updated
09/11/2025
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