Healthcare Provider Details

I. General information

NPI: 1164677167
Provider Name (Legal Business Name): CHERYL A. ROSS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S ACADEMY RD
GUTHRIE OK
73044-8727
US

IV. Provider business mailing address

205 S ACADEMY RD
GUTHRIE OK
73044-8727
US

V. Phone/Fax

Practice location:
  • Phone: 405-282-9449
  • Fax: 405-828-9403
Mailing address:
  • Phone: 405-282-9449
  • Fax: 405-828-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number62010
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF1008203
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: