Healthcare Provider Details

I. General information

NPI: 1295097269
Provider Name (Legal Business Name): KAREN CHRISTINE ROSS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 WEST FREEDOM DRIVE
LIBERTY MS
39645
US

IV. Provider business mailing address

P O BOX 511
LIBERTY MS
39645
US

V. Phone/Fax

Practice location:
  • Phone: 601-657-8091
  • Fax:
Mailing address:
  • Phone: 601-657-4326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR871215
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN107115
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: