MEDICARE: MR. LOUIE GREG ROSS FNP-BC

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	363LF0000X	Family Nurse Practitioner	R836293	MS

General Provider Information

NPI Number	:	1801933031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LOUIE GREG ROSS FNP-BC

Provider Business Mailing Address
First Line	:	1220 N SHORE PKWY STE A
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39047-6383
Country	:	US
Telephone Number	:	601-829-2939
Fax Number	:	601-829-2995

Provider Business Practice Location Address
First Line	:	1201 HIGHWAY 49 S STE 4
Second Line	:
City	:	RICHLAND
State	:	MS
Zip	:	39218-9438
Country	:	US
Telephone Number	:	601-932-6400
Fax Number	:	601-664-0006

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/31/2023

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