Provider Demographics
NPI:1619212958
Name:ROSS, GINA MICHELLE (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MICHELLE
Last Name:ROSS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 KEMP BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308
Mailing Address - Country:US
Mailing Address - Phone:940-692-1220
Mailing Address - Fax:940-689-5767
Practice Address - Street 1:6515 KEMP BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-5419
Practice Address - Country:US
Practice Address - Phone:940-692-1220
Practice Address - Fax:940-689-5784
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX617104363LP0808X
TXAP122796363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health