Basic Information
| Provider Information | |||||||||
| NPI: | 1093182180 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | KIRBY | ||||||||
| MiddleName: | BUERKLEY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 909 KENTON STATION DR | ||||||||
| Address2: | |||||||||
| City: | MAYSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410569616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067594050 | ||||||||
| FaxNumber: | 6067591207 | ||||||||
| Practice Location | |||||||||
| Address1: | 927 KENTON STATION DR | ||||||||
| Address2: | |||||||||
| City: | MAYSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410569617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067590433 | ||||||||
| FaxNumber: | 6067590058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2015 | ||||||||
| LastUpdateDate: | 06/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 3009596 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0266707 | 05 | OH | MEDICAID | 7100460070 | 05 | KY | MEDICAID |