Provider Demographics
NPI:1972309078
Name:ROSS, KYONNA
Entity type:Individual
Prefix:
First Name:KYONNA
Middle Name:
Last Name:ROSS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 49396
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-0396
Mailing Address - Country:US
Mailing Address - Phone:888-423-2559
Mailing Address - Fax:
Practice Address - Street 1:390 S LOWE AVE STE K
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4703
Practice Address - Country:US
Practice Address - Phone:888-423-2559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician