Provider Demographics
NPI:1689439945
Name:AEGER ROSS, CHARLOTTE MARIE (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:MARIE
Last Name:AEGER 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 1:12456 JOHN LEE RD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-9646
Mailing Address - Country:US
Mailing Address - Phone:228-861-0707
Mailing Address - Fax:
Practice Address - Street 1:124 SUMMER ST STE D
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-5918
Practice Address - Country:US
Practice Address - Phone:601-530-5317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906505363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health