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General NPI Number Information
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NPI Number | 1063539823
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Entity Type | Individual
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Provider Name | SYREETA LYNN VAN ROSS
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Gender | Female
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Dates
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Enumeration Date | 03/24/2007
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 16659 E 23RD ST S
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City | INDEPENDENCE
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State | MO
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Zip | 64055-1922
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Country | US
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Telephone | 816-631-1885
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 740019
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City | ATLANTA
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State | GA
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Zip | 30374-0019
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Country | US
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Telephone | 773-644-3941
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2015039584
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 2015039584
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 77550-072
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 200380880A
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License Number State | KS
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