=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679361380
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AIMEE ROSS RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2025
-----------------------------------------------------
Last Update Date | 05/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2551 GREENWOOD RD STE 130
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71103-3984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-212-8627
-----------------------------------------------------
Fax | 318-212-8632
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2551 GREENWOOD RD STE 130
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71103-3984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-212-8627
-----------------------------------------------------
Fax | 318-212-8632
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WD0400X
-----------------------------------------------------
Taxonomy Name | Diabetes Educator Registered Nurse
-----------------------------------------------------
License Number | RN089862
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------