Individual
TRACY L ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1387 W 4TH ST, TAHLEQUAH, OK 74464-9766
(918) 453-5554
(918) 431-4112
Mailing address
1387 W 4TH ST, TAHLEQUAH, OK 74464-9766
(918) 453-5554
(918) 431-4112
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
A01450ANP
AR
363LG0600X
Gerontology Nurse Practitioner
09035013
OK
Other
Enumeration date
06/23/2009
Last updated
07/23/2010
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