Provider Demographics
NPI:1063836682
Name:ROSS, COLBY
Entity Type:Individual
Prefix:
First Name:COLBY
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 N SEVENTH ST
Mailing Address - Street 2:
Mailing Address - City:OBION
Mailing Address - State:TN
Mailing Address - Zip Code:38240-3859
Mailing Address - Country:US
Mailing Address - Phone:731-697-1638
Mailing Address - Fax:
Practice Address - Street 1:413 N SEVENTH ST
Practice Address - Street 2:
Practice Address - City:OBION
Practice Address - State:TN
Practice Address - Zip Code:38240-3859
Practice Address - Country:US
Practice Address - Phone:731-697-1638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18378363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily