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General NPI Number Information
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NPI Number | 1386407815
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Entity Type | Individual
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Provider Name | KATHERINE BROOKE ROSS
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Gender | Female
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Dates
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Enumeration Date | 02/06/2024
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 1009 HILLPOINT BLVD N
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City | SUFFOLK
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State | VA
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Zip | 23434-8470
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Country | US
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Telephone | 757-668-2250
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Fax |
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Provider Business Mailing Address
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Address Line | 18421 ORBIT RD
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City | WINDSOR
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State | VA
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Zip | 23487-6670
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Country | US
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Telephone | 757-817-3866
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 0024182785
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License Number State | VA
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