Provider Demographics
NPI:1245298272
Name:WEST, ROSS KENNETH (FNP-BC, ACNP-BC)
Entity type:Individual
Prefix:MR
First Name:ROSS
Middle Name:KENNETH
Last Name:WEST
Suffix:
Gender:M
Credentials:FNP-BC, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11226 HILLSIDE GLEN TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5024
Mailing Address - Country:US
Mailing Address - Phone:832-668-4240
Mailing Address - Fax:
Practice Address - Street 1:6565 FANNIN ST
Practice Address - Street 2:MGJ 11-002
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-441-4515
Practice Address - Fax:713-441-4427
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2013-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX549721363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152579204Medicaid
TX152579204Medicaid