Healthcare Provider Details

I. General information

NPI: 1881797694
Provider Name (Legal Business Name): STACEY L. ROSS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 CLEARVISTA DR STE 100
INDIANAPOLIS IN
46256-1695
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-7111
  • Fax: 317-621-6040
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003191A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number28144441A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: