Grismeldy E Gomez
Individual provider Active NPI Primary Care Nurse Practitioner · Winfield, MO
NPI 1992369508 · NPPES record last updated Jun 15, 2019
Key facts
- NPI
- 1992369508
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Primary Care Nurse Practitioner 363LP2300X
- License
- 53-78743-011 (KS)
- Practice address
- 61 Village Circle Dr
Winfield, MO 63389-2053 - Phone
- (636) 322-8517
- NPI assigned
- Apr 29, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2013026395 | MO | MD | Registered Nurse |
| 53-78743-011 | KS | MD | Primary Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Meade Hospital District | Current | Accepting new patients | |
| Meade Hospital District | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 2013026395 | MO | |
| Primary Care Nurse Practitioner | 363LP2300X | 53-78743-011 | KS | Yes |
Addresses
Primary practice location
61 Village Circle Dr
Winfield, MO 63389-2053
Mailing address
61 Village Circle Dr
Winfield, MO 63389-2053
Phone (636) 322-8517
Other providers in Winfield, MO
- Tara K Diggs
- Jessica Muensterman Downs
- Elise Dunard
- Candice Erickson
- Crystal French
- Kelly Hahn
- Kris Marie Henderson
- Integrated Health and Wellness LLC
- Melanie Kozel
- Kaitlyn Lewis
All providers in Winfield, MO · Primary Care Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.