Provider Demographics
NPI:1477630853
Name:ROSS, KARLA (NP)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3750 LANDMARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-6633
Mailing Address - Country:US
Mailing Address - Phone:765-448-4511
Mailing Address - Fax:765-447-8375
Practice Address - Street 1:3750 LANDMARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-6633
Practice Address - Country:US
Practice Address - Phone:765-448-4511
Practice Address - Fax:765-447-8375
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71000438363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INS61100Medicare UPIN
IN160120IMedicare PIN
IN151560I4Medicare PIN