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General NPI Number Information
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NPI Number | 1003749813
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Entity Type | Individual
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Provider Name | DEVRA ROSE BSN, RN
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Gender | Female
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Dates
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Enumeration Date | 06/03/2026
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Last Update Date | 06/03/2026
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Provider Practice Location Address
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Address Line | 206 S CLAY ST
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City | ENNIS
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State | TX
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Zip | 75119-4527
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Country | US
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Telephone | 903-600-8358
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Fax |
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Provider Business Mailing Address
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Address Line | 860 FM 2377
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City | RED OAK
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State | TX
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Zip | 75154-6805
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Country | US
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Telephone | 214-517-1019
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 1038518
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License Number State | TX
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