NPIMap

Organization Active NPI

Kaye M. Grossnickle, LLC

  • Family Nurse Practitioner
  • Fort Dodge, IA
National Provider Identifier
1992905780
Registry record updated Jan 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A063458 Issued in IA
Legal business name
KAYE M. GROSSNICKLE, LLC
Practice address
809 Central Ave
Suite 420
Fort Dodge, IA 50501-3936
Phone
(515) 955-1836
Fax
(515) 955-7115
NPI assigned
Jul 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Kaye Grossnickle, ARNP
Title
President
Phone
(515) 955-1836

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X A063458 IA Primary

Addresses

Primary practice location

809 Central Ave
Suite 420
Fort Dodge, IA 50501-3936

Mailing address

PO Box 261
Fort Dodge, IA 50501-0261
Phone (515) 955-1836

Other identifiers 2

IdentifierTypeStateIssuer
0291153MedicaidIA
34971OtherIABCBS NUMBER

Other names 1

  • lincoln mental health Other name

National Provider Directory

National Provider Directory

Locations

809 Central Ave
Ste 420
Fort Dodge, IA 50501
Phone (515) 955-1836

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199318400000",
    "number": "1992905780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 261",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505010261",
            "telephone_number": "515-955-1836",
            "fax_number": "515-955-7115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 CENTRAL AVE",
            "address_2": "SUITE 420",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505013936",
            "telephone_number": "515-955-1836",
            "fax_number": "515-955-7115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAYE M. GROSSNICKLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-20",
        "last_updated": "2008-01-03",
        "status": "A",
        "authorized_official_last_name": "GROSSNICKLE",
        "authorized_official_first_name": "KAYE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "515-955-1836",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "IA",
            "license": "A063458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0291153",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NUMBER",
            "identifier": "34971",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "lincoln mental health",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Dodge, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.