Provider Demographics
NPI:1003323106
Name:ROSS, KIMBERLY ELAINE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ELAINE
Last Name:ROSS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-1252
Mailing Address - Country:US
Mailing Address - Phone:812-677-6809
Mailing Address - Fax:
Practice Address - Street 1:404 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-1252
Practice Address - Country:US
Practice Address - Phone:812-677-6809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28083811A163W00000X
IN71007768A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse