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General NPI Number Information
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NPI Number | 1689439945
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Entity Type | Individual
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Provider Name | CHARLOTTE MARIE AEGER ROSS PMHNP
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Gender | Female
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 124 SUMMER ST STE D
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City | LUCEDALE
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State | MS
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Zip | 39452-5918
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Country | US
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Telephone | 601-530-5317
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Fax |
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Provider Business Mailing Address
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Address Line | 12456 JOHN LEE RD
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City | BILOXI
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State | MS
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Zip | 39532-9646
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Country | US
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Telephone | 228-861-0707
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 906505
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License Number State | MS
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