Provider Demographics
NPI:1043634744
Name:ROSS, ROBYNN ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:ROBYNN
Middle Name:ELIZABETH
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ROBYNN
Other - Middle Name:ELIZABETH
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:3509 HIGHWAY 4 W
Mailing Address - Street 2:
Mailing Address - City:SARAH
Mailing Address - State:MS
Mailing Address - Zip Code:38665-3567
Mailing Address - Country:US
Mailing Address - Phone:662-612-6411
Mailing Address - Fax:662-612-6414
Practice Address - Street 1:3509 HIGHWAY 4 W
Practice Address - Street 2:
Practice Address - City:SARAH
Practice Address - State:MS
Practice Address - Zip Code:38665-3567
Practice Address - Country:US
Practice Address - Phone:662-612-6411
Practice Address - Fax:662-612-6414
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-15
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR857637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily