=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447890066
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW ROSS FNP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2020
-----------------------------------------------------
Last Update Date | 07/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 311 W MAIN ST
-----------------------------------------------------
City | SAINT PARIS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43072-9705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-404-9755
-----------------------------------------------------
Fax | 937-404-9756
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 696
-----------------------------------------------------
City | SAINT PARIS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43072-0696
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-404-9755
-----------------------------------------------------
Fax | 937-404-9756
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.026445
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------