Healthcare Provider Details

I. General information

NPI: 1679361380
Provider Name (Legal Business Name): AIMEE ROSS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 GREENWOOD RD STE 130
SHREVEPORT LA
71103-3984
US

IV. Provider business mailing address

2551 GREENWOOD RD STE 130
SHREVEPORT LA
71103-3984
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-8627
  • Fax: 318-212-8632
Mailing address:
  • Phone: 318-212-8627
  • Fax: 318-212-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN089862
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: