Provider Demographics
NPI:1376130252
Name:FORD-ROSS, PHELICIA NICHOLE (APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:PHELICIA
Middle Name:NICHOLE
Last Name:FORD-ROSS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 LONGHORN WAY
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3750
Mailing Address - Country:US
Mailing Address - Phone:210-410-9178
Mailing Address - Fax:
Practice Address - Street 1:3327 RESEARCH PLZ STE 307
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78235-5158
Practice Address - Country:US
Practice Address - Phone:210-337-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF11200497363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily