Provider Demographics
NPI:1891891602
Name:ROSS, BONNIE R (RN, FNP)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:R
Last Name:ROSS
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:1415 SANTA FE ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2105
Practice Address - Country:US
Practice Address - Phone:361-887-4521
Practice Address - Fax:361-887-4906
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256812363LF0000X
TXAP103188363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190827902Medicaid
TX446073YMJMMedicare PIN
TX8Y3807OtherBCBS
TX8D5493Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER