Healthcare Provider Details

I. General information

NPI: 1891961298
Provider Name (Legal Business Name): GORDON KEITH ROSS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9708 BUSINESS PKWY STE 118
HELOTES TX
78023-4742
US

IV. Provider business mailing address

11634 FOXFORD
SAN ANTONIO TX
78253-6026
US

V. Phone/Fax

Practice location:
  • Phone: 210-372-9898
  • Fax:
Mailing address:
  • Phone: 210-771-9688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number662304
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number662304
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number662304
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number662304
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: