| Doctor Name: | LESLIE ROSS |
| NPI Number: | 1447640669 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | AP127305 |
| Business Practice Address: | 1008 Ne Big Bend Trl Glen Rose, TX - 760434947 |
| Business Phone Number: | 2548973444 |
| Business Fax Number: | 2548980495 |
| Mailing Address: | Po Box 2279, GLEN ROSE |
| State: | TX |
| Postal Code: | 760432279 |
| Phone Number: | 2548973444 |
| Fax Number: | 2548980495 |
| NPI Enumeration Date: | 01/26/2015 |
| NPI Last Update Date: | 03/29/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP127305 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |