MEDICARE: KATOYA ROSS CFLE-P

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1457771115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATOYA ROSS CFLE-P

Provider Business Mailing Address
First Line	:	12920 WESTPARK PL
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-4402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12600 N MACARTHUR BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-2939
Country	:	US
Telephone Number	:	405-420-8770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2014
Last Update Date	:	04/20/2021

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