Healthcare Provider Details

I. General information

NPI: 1336901594
Provider Name (Legal Business Name): JOSEPH ANDREW ROSE BSN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DREW ROSE BSN, FNP-BC

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 01/24/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 SUNSET DR STE 101
GRENADA MS
38901-4080
US

IV. Provider business mailing address

1117 SUNSET DR STE 101
GRENADA MS
38901-4080
US

V. Phone/Fax

Practice location:
  • Phone: 662-227-1744
  • Fax:
Mailing address:
  • Phone: 662-699-0171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberROSE-7L4909
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: