Provider Demographics
NPI:1306084728
Name:ROSS, KELLEY N (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:N
Last Name:ROSS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:NICHOLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:200 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276-1050
Mailing Address - Country:US
Mailing Address - Phone:304-927-4444
Mailing Address - Fax:304-927-6837
Practice Address - Street 1:200 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276-1050
Practice Address - Country:US
Practice Address - Phone:304-927-6812
Practice Address - Fax:304-927-6393
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV58584363L00000X
WVAPRN58584363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner