Healthcare Provider Details

I. General information

NPI: 1235578212
Provider Name (Legal Business Name): WESLEY TODD ROSS NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2013
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 SUMMA AVE
BATON ROUGE LA
70809-3726
US

IV. Provider business mailing address

13160 MOSS POINTE DR
GEISMAR LA
70734-3064
US

V. Phone/Fax

Practice location:
  • Phone: 225-761-5479
  • Fax: 225-761-5702
Mailing address:
  • Phone: 225-937-7712
  • Fax: 225-313-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP07244
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: