Healthcare Provider Details

I. General information

NPI: 1326925322
Provider Name (Legal Business Name): KRISTEN ROSS AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10515 W SANTA FE DR
SUN CITY AZ
85351-3020
US

IV. Provider business mailing address

1802 E MARLETTE AVE
PHOENIX AZ
85016-1517
US

V. Phone/Fax

Practice location:
  • Phone: 623-832-6530
  • Fax:
Mailing address:
  • Phone: 623-210-6298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number328331
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: