Mary Jo Koller, FNP-BC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN218765 Issued in GA

Practice address

504 Redmond Rd NW
Rome, GA 30165-1416

Phone

(706) 235-3855

Fax

(706) 290-2721

NPI assigned

Jun 28, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465776000000",
    "number": "1124055686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 TECHNOLOGY PKWY NW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301651369",
            "telephone_number": "706-295-5331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 REDMOND RD NW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301651416",
            "telephone_number": "706-235-3855",
            "fax_number": "706-290-2721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLER",
        "first_name": "MARY",
        "middle_name": "JO",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2016-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN218765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Knight, MD
• Heather Knowles, MS.CCC-SLP
• Sara Caitlin Kitchen Koch, MPH, RD, LD
• Priyanka Kodali, MD
• Pepa Koleva, FNP-C
• Kondyles Chiropractic PC
• Andrew N Kondyles, DC
• Don S Koshute, ATC
• Gwendolyn Jane Kossick, R.D.
• Holly Angelyne Kozera, OT

• Nurse Practitioner in Rome, GA
• Providers in Rome, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.