Active NPI
Lisa Roth
- Nurse's Aide
- Saint Mary, MO
National Provider Identifier
1346612272
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse's Aide
- License
- 100656A
- Practice address
- 22294 Coffelt Rd
Saint Mary, MO 63673-9225 - Phone
- (573) 535-4538
- NPI assigned
- Oct 30, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | 100656A | MO | Primary |
Addresses
Primary practice location
22294 Coffelt Rd
Saint Mary, MO 63673-9225
Mailing address
22294 Coffelt Rd
Saint Mary, MO 63673-9225
Phone (573) 535-4538
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100656A | MO | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446163200000",
"number": "1346612272",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22294 COFFELT RD",
"city": "SAINT MARY",
"state": "MO",
"postal_code": "636739225",
"telephone_number": "573-535-4538"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22294 COFFELT RD",
"city": "SAINT MARY",
"state": "MO",
"postal_code": "636739225",
"telephone_number": "573-535-4538"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTH",
"first_name": "LISA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-10-30",
"last_updated": "2015-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "MO",
"license": "100656A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Mary, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.