Healthcare Provider Details

I. General information

NPI: 1447890066
Provider Name (Legal Business Name): MATTHEW ROSS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2020
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date: 03/04/2020
Reactivation Date: 03/18/2020

III. Provider practice location address

311 W MAIN ST
SAINT PARIS OH
43072-9705
US

IV. Provider business mailing address

PO BOX 696
SAINT PARIS OH
43072-0696
US

V. Phone/Fax

Practice location:
  • Phone: 937-404-9755
  • Fax: 937-404-9756
Mailing address:
  • Phone: 937-404-9755
  • Fax: 937-404-9756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.026445
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: