Provider Demographics
NPI:1871275800
Name:ROSS, KYMMALETT ANNTYONETTE (PHD)
Entity type:Individual
Prefix:
First Name:KYMMALETT
Middle Name:ANNTYONETTE
Last Name:ROSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CABES MILL RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-1405
Mailing Address - Country:US
Mailing Address - Phone:931-302-3638
Mailing Address - Fax:
Practice Address - Street 1:130 PRESTON EXECUTIVE DR STE 202
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8433
Practice Address - Country:US
Practice Address - Phone:931-302-3638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist