Provider Demographics
NPI:1215720230
Name:ROSS-KIRKLAND, KOWJUANA
Entity type:Individual
Prefix:MRS
First Name:KOWJUANA
Middle Name:
Last Name:ROSS-KIRKLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9516 ROSSPORT WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-6029
Mailing Address - Country:US
Mailing Address - Phone:916-870-4056
Mailing Address - Fax:
Practice Address - Street 1:9516 ROSSPORT WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-6029
Practice Address - Country:US
Practice Address - Phone:916-870-4056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker