Provider Demographics
NPI:1831239284
Name:ROSS, JAMIE V (APRN)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:V
Last Name:ROSS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:MORROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2700 STANLEY GAULT PKWY
Mailing Address - Street 2:STE 129
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:270-326-3949
Mailing Address - Fax:270-326-3954
Practice Address - Street 1:500 CLINIC DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-4991
Practice Address - Country:US
Practice Address - Phone:270-707-3354
Practice Address - Fax:270-707-3351
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004906363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000508864OtherBCBS PROVIDER NUMBER
KY7100007700Medicaid
KY0683243Medicare PIN
P00403292Medicare PIN
KY0396861Medicare PIN
KY7100007700Medicaid
KY0745832Medicare PIN
KY0771923Medicare PIN
KYP400041323Medicare PIN
KY00151022Medicare PIN
KY0935815Medicare PIN
KY0525688Medicare PIN
KY0685604Medicare PIN
0903685Medicare PIN
KY0952015Medicare PIN
KY00280023Medicare PIN