Healthcare Provider Details

I. General information

NPI: 1669376364
Provider Name (Legal Business Name): DAMISHA ROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21621 MERCHANTS WAY APT 1006
KATY TX
77449-1224
US

IV. Provider business mailing address

21621 MERCHANTS WAY APT 1006
KATY TX
77449-1224
US

V. Phone/Fax

Practice location:
  • Phone: 414-331-8208
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number1145038
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: