Healthcare Provider Details

I. General information

NPI: 1114556651
Provider Name (Legal Business Name): KEVELYN ASHLEY ROSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 TOWN PL
FAIRVIEW TX
75069-1825
US

IV. Provider business mailing address

331 TOWN PL
FAIRVIEW TX
75069-1825
US

V. Phone/Fax

Practice location:
  • Phone: 972-747-0000
  • Fax: 972-736-4020
Mailing address:
  • Phone: 972-747-0000
  • Fax: 972-736-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberV1878
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: