Individual
MRS. JACQUELINE DIANE ROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
12509 PLEASANT FOREST DR, LITTLE ROCK, AR 72212-2214
(479) 200-0417
Mailing address
12509 PLEASANT FOREST DR, LITTLE ROCK, AR 72212-2214
(479) 200-0417
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT 604
AR
Other
Enumeration date
02/12/2014
Last updated
02/12/2014
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