Active NPI
Kelly Rottinghaus
- Specialist
- Jonesboro, AR
National Provider Identifier
1184047490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Practice address
- 1801 Grant Ave
Jonesboro, AR 72401-6155 - Phone
- (870) 974-9114
- Fax
- (870) 974-9184
- NPI assigned
- Jan 23, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | AR | Primary |
Addresses
Primary practice location
1801 Grant Ave
Jonesboro, AR 72401-6155
Mailing address
1801 Grant Ave
Jonesboro, AR 72401-6155
Phone (870) 974-9114
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 198473795 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1390435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1184047490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1801 GRANT AVE",
"city": "JONESBORO",
"state": "AR",
"postal_code": "724016155",
"telephone_number": "870-974-9114",
"fax_number": "870-974-9184"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 GRANT AVE",
"city": "JONESBORO",
"state": "AR",
"postal_code": "724016155",
"telephone_number": "870-974-9114",
"fax_number": "870-974-9184"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTTINGHAUS",
"first_name": "KELLY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-01-23",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "AR",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "198473795",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jonesboro, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.