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Individual
SHELLEY ROSS
Active
Individual
SHELLEY ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
30404
TN
363L00000X
Nurse Practitioner
NP12292
CA
363LF0000X
Family Nurse Practitioner
Primary
30404
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447410519
GROUP NPI
—
01
—
1720247455
GROUP NPI
—
01
—
1912919804
GROUP NPI
—
01
—
500017017
RAIL ROAD MEDICARE - PROVIDER PTAN
CA
01
—
CG5665
RAIL ROAD MEDICARE - GROUP PTAN
CA
01
—
W11996
GROUP MEDICARE PTAN
CA
01
—
W1514
GROUP MEDICARE PTAN
CA
01
—
W1514B
GROUP MEDICARE PTAN
CA
Enumeration date
03/14/2006
Last updated
04/02/2024
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