Addie Roderick, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP3930 Issued in AZ

Practice address

105 S Delaware Dr Ste 2
Apache Junction, AZ 85120-6512

Phone

(480) 646-1001

Fax

(480) 646-1002

NPI assigned

May 26, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Heavens Urgent Care LLC

  dba Heavens Urgent Care

  • Urgent Care Clinic/Center
  • Apache Junction, AZ
  • NPI 1578065827
  NPD (past)
• No Appointment MD

  • Medical Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1942429923
  NPD (past)
• Southeastern Emergency Services of Memphis, P.C.

  • Emergency Medicine Physician
  • Chattanooga, TN
  • NPI 1164454450

  Nurse Practitioner

  NPD (past)

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1447206529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 S DELAWARE DR STE 1",
            "city": "APACHE JUNCTION",
            "state": "AZ",
            "postal_code": "851206512",
            "telephone_number": "480-646-1001",
            "fax_number": "480-646-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S DELAWARE DR STE 2",
            "city": "APACHE JUNCTION",
            "state": "AZ",
            "postal_code": "851206512",
            "telephone_number": "480-646-1001",
            "fax_number": "480-646-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODERICK",
        "first_name": "ADDIE",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-26",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "APN6179",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP3930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "AP3930",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78013760",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS",
            "identifier": "4087938",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "653785",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angelina Renna, LAC
• Jane Richards, MSW
• Jamie Linnea Richardson, FNP
• Tyler Robbins, RN
• Alia Rocha
• Samantha Mercedes Rodriguez, BA, BHT
• W. Owen Rogers, R.PH.
• Elizabeth A Romeo, FNP
• Rooted Hopes, Inc.
• Herbert Dietmar Rosenberg, DC

• Family Nurse Practitioner in Apache Junction, AZ
• Providers in Apache Junction, AZ by specialty
• Family Nurse Practitioner in Arizona

• 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.

Verify at the official NPI Registry.