Provider Demographics
NPI:1497419865
Name:GONZALEZ, MARY ROSE (APRN-CNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ROSE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:APRN-CNP, 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:PO BOX 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:708 HILL COUNTRY DR STE 400
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6071
Practice Address - Country:US
Practice Address - Phone:830-896-1433
Practice Address - Fax:830-896-1440
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2024-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1057294363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner