Individual
TIFFANY L GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
1025 S MAIN STREET, MONTICELLO, KY 42633-2762
(606) 340-8870
(606) 340-9828
Mailing address
PO BOX 1080, BURKESVILLE, KY 42717-1080
(270) 858-6655
(270) 858-4607
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
3018327
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15644251
CAQH
—
05
—
7100848360
—
KY
Enumeration date
06/20/2022
Last updated
07/13/2023
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