Provider Demographics
NPI:1154477651
Name:ROSS, JULIE A (APRN, PMHNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:ROSS
Suffix:
Gender:F
Credentials:APRN, PMHNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312C HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2830
Mailing Address - Country:US
Mailing Address - Phone:601-684-8284
Mailing Address - Fax:601-684-8199
Practice Address - Street 1:1312C HARRISON AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648
Practice Address - Country:US
Practice Address - Phone:601-684-8284
Practice Address - Fax:601-684-8199
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR672718363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08178571Medicaid
MS500001887Medicare ID - Type Unspecified
MS08178571Medicaid