Doctor Name: | TRACY L ROSS |
NPI Number: | 1083842520 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 09035013 |
Business Practice Address: | 1387 W 4th St Tahlequah, OK - 744649766 |
Business Phone Number: | 9184535554 |
Business Fax Number: | 9184314112 |
Mailing Address: | 1387 W 4th St, TAHLEQUAH |
State: | OK |
Postal Code: | 744649766 |
Phone Number: | 9184535554 |
Fax Number: | 9184314112 |
NPI Enumeration Date: | 06/23/2009 |
NPI Last Update Date: | 07/23/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LG0600X |
License Number: | 09035013 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OK |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Gerontology |
Taxonomy Definition: |