Provider Demographics
NPI:1780061044
Name:ROSS, HEATHER TAYLOR (CRNA)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:TAYLOR
Last Name:ROSS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5918 SILTSTONE LN
Mailing Address - Street 2:APT 616
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-8003
Mailing Address - Country:US
Mailing Address - Phone:318-548-3483
Mailing Address - Fax:
Practice Address - Street 1:5918 SILTSTONE LN
Practice Address - Street 2:APT 616
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-8003
Practice Address - Country:US
Practice Address - Phone:318-548-3483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX853589367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1B1038OtherMEDICARE
TX8MQ124OtherBCBS
TXP02469547OtherMEDICARE RAIL ROAD