Healthcare Provider Details

I. General information

NPI: 1437242724
Provider Name (Legal Business Name): KYMBERLY RAVEN ROSS CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KYMBERLY RAVEN VAN EVERY

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 JACKSON AVE W
OXFORD MS
38655-2154
US

IV. Provider business mailing address

301 JACKSON AVE W
OXFORD MS
38655-2154
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-6464
  • Fax: 662-234-6475
Mailing address:
  • Phone: 662-234-6464
  • Fax: 662-234-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10818
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR878897
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number72556
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1116194
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN0000010481
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR878897
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: