Provider Demographics
NPI:1790101509
Name:ROSS, KATHERINE (AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27036
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7036
Mailing Address - Country:US
Mailing Address - Phone:212-305-9576
Mailing Address - Fax:212-305-9480
Practice Address - Street 1:177 FORT WASHINGTON AVE
Practice Address - Street 2:MHB 7-435 GN
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3733
Practice Address - Country:US
Practice Address - Phone:212-305-6003
Practice Address - Fax:212-305-0907
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306664-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health