Basic Information
| Provider Information | |||||||||
| NPI: | 1154477651 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | APRN, PMHNP, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1312C HARRISON AVE | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396482830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016848284 | ||||||||
| FaxNumber: | 6016848199 | ||||||||
| Practice Location | |||||||||
| Address1: | 1312C HARRISON AVE | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016848284 | ||||||||
| FaxNumber: | 6016848199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 07/18/2018 | ||||||||
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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 | 363LP0808X | R672718 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 08178571 | 05 | MS | MEDICAID |