Abby Rose Roth, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R-161224-8 Issued in MN

Practice address

4241 Johnny Cake Ridge Rd
Eagan, MN 55122-2235

Phone

(866) 389-2727

NPI assigned

Dec 20, 2012

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

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1355961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355961600000",
    "number": "1134465065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2240 E 42ND ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073049",
            "telephone_number": "507-269-4279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4241 JOHNNY CAKE RIDGE RD",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222235",
            "telephone_number": "866-389-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "ABBY",
        "middle_name": "ROSE",
        "name_prefix": "Ms.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-20",
        "last_updated": "2012-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R-161224-8",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Johnny Roman
• Kayleen Marie Rooney, D.C.
• Victoria Guadalupe Rosas
• Kara Beth Rose
• Sagit Rosenberg, MD
• Bernie V Rottach, O.D.
• Sondra Rowley, PTA
• Alexander Joseph Rud, DMD
• Jeffrey Allen Rud, DDS
• Timothy J. Ruden, PH.D.

• Family Nurse Practitioner in Eagan, MN
• Providers in Eagan, MN by specialty
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2012; 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.