Theresa L Roth, RN

Primary specialty

Adult Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0809X

License

28112127A Issued in IN

Practice address

909 E State Blvd
Fort Wayne, IN 46805-3404

Phone

(260) 481-2700

Fax

(260) 481-2717

NPI assigned

Dec 12, 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)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194886697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 E STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468053404",
            "telephone_number": "260-481-2700",
            "fax_number": "260-481-2717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 E STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468053404",
            "telephone_number": "260-481-2700",
            "fax_number": "260-481-2717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "THERESA",
        "middle_name": "L",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "IN",
            "license": "28112127A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Helen Catherine Rossman, MS, MSED, NP-C
• Adam Roth, CO
• Daniel Christopher Roth, DO, MBA, MS
• Meredith Roth, PA-C
• Su Roth
• Zachary D Roth, O.D.
• Holly Nicole Rothenbush, LMFT
• Amanda Rothgeb
• Michale Diane Rothgeb, PTA
• Rachael M Rothgeb, DPT

• Adult Psychiatric/Mental Health Registered Nurse in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Adult Psychiatric/Mental Health Registered Nurse in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.