Kristina Lynn Wagner Ross, MSN, APRN, FNP-BC
Individual provider Active NPI Family Medicine Physician · Sycamore, IL
NPI 1649969023 · NPPES record last updated May 2, 2023
Key facts
- NPI
- 1649969023
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 209027267 (IL)
- Practice address
- 2560 Hauser Ross Dr Ste 425
Sycamore, IL 60178-3194 - Phone
- (815) 784-6300
- NPI assigned
- May 2, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science - Nursing, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209027267 | IL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Telelact Inc | Current |
Accepting new patients | |
| Family First Physicians SC | Family Medicine | Past |
Accepting new patients |
Locations
2560 Hauser Ross Dr
Ste 425
Sycamore, IL 60178
Phone (815) 784-6300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 209027267 | IL | Yes |
Addresses
Primary practice location
2560 Hauser Ross Dr Ste 425
Sycamore, IL 60178-3194
Mailing address
2560 Hauser Ross Dr Ste 425
Sycamore, IL 60178-3194
Phone (815) 784-6300
Other providers in Sycamore, IL
- Nicole Rodiek
- Mel Roethlisberger
- Dahlia Roman
- Rachael Anne Romba
- Dominique M Ross
- Allison Rothamer
- Courtney Rowell II
- Catherine A Ruetten
- Timothy J Ruetten
- Amanda Ruppert
All providers in Sycamore, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 2, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.