Provider Demographics
NPI:1235578212
Name:ROSS, WESLEY TODD (NP-C)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:TODD
Last Name:ROSS
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:13160 MOSS POINTE DR
Mailing Address - Street 2:
Mailing Address - City:GEISMAR
Mailing Address - State:LA
Mailing Address - Zip Code:70734-3064
Mailing Address - Country:US
Mailing Address - Phone:225-937-7712
Mailing Address - Fax:225-313-4450
Practice Address - Street 1:9001 SUMMA AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3726
Practice Address - Country:US
Practice Address - Phone:225-761-5479
Practice Address - Fax:225-761-5702
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAP07244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily