Provider Demographics
NPI:1710433909
Name:ROSS, AMY (NP-C, FNP-BC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:NP-C, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N LIMESTONE ST STE 125
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-1114
Mailing Address - Country:US
Mailing Address - Phone:937-523-9070
Mailing Address - Fax:937-523-9089
Practice Address - Street 1:2600 N LIMESTONE ST STE 125
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-1114
Practice Address - Country:US
Practice Address - Phone:937-523-9070
Practice Address - Fax:937-523-9089
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.19233363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0186542Medicaid
OHH508300Medicare PIN