Provider Demographics
NPI:1386407815
Name:ROSS, KATHERINE BROOKE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BROOKE
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18421 ORBIT RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:VA
Mailing Address - Zip Code:23487-6670
Mailing Address - Country:US
Mailing Address - Phone:757-817-3866
Mailing Address - Fax:
Practice Address - Street 1:1009 HILLPOINT BLVD N
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8470
Practice Address - Country:US
Practice Address - Phone:757-668-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182785363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics