Teresa Beth Rose, LICENSEDPSYCHOLOGIST

Primary specialty

PsychologistTaxonomy code 103T00000X

License

1262 Issued in KS

Practice address

4200 Somerset Dr
Suite 239
Prairie Village, KS 66208-5217

Phone

(816) 363-9500

NPI assigned

Jul 21, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1326069030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3965 W 83RD STREET #182",
            "city": "PRAIRIE VILLAGE",
            "state": "KS",
            "postal_code": "66208",
            "telephone_number": "816-363-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 SOMERSET DR",
            "address_2": "SUITE 239",
            "city": "PRAIRIE VILLAGE",
            "state": "KS",
            "postal_code": "662085217",
            "telephone_number": "816-363-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "TERESA",
        "middle_name": "BETH",
        "name_prefix": "Dr.",
        "credential": "LICENSEDPSYCHOLOGIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-21",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MO",
            "license": "2000167702",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "KS",
            "license": "1262",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC UBH",
            "identifier": "6183141",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "30786016",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Prairie Village, KS
• Providers in Prairie Village, KS by specialty
• Psychologist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; 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.