Provider Demographics
NPI:1215430616
Name:ROSS, PAUL JAMES (PA-C)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:JAMES
Last Name:ROSS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WILDCAT DR
Mailing Address - Street 2:
Mailing Address - City:OIL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:41238-9107
Mailing Address - Country:US
Mailing Address - Phone:606-496-8834
Mailing Address - Fax:
Practice Address - Street 1:11087 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649-7999
Practice Address - Country:US
Practice Address - Phone:606-285-3690
Practice Address - Fax:606-285-1443
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2361363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant