Individual provider Active NPI

Rosanna Nicole Rubley, APRN

  • Family Nurse Practitioner
  • Bentonville, AR
National Provider Identifier
1508399502
Registry record updated Apr 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A005115 Issued in AR
Practice address
4100 SW I St # 200
Bentonville, AR 72713-0200
Phone
(479) 268-7640
Fax
(479) 250-9817
NPI assigned
Apr 6, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X A005115 AR Primary

Addresses

Primary practice location

4100 SW I St # 200
Bentonville, AR 72713-0200

Mailing address

4100 SW I St # 200
Bentonville, AR 72713-0200
Phone (479) 268-7640

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170510002320 AR Practitioner - Nurse Practitioner 9739466210 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Health Northwest Arkansas CommunitiesGroup PAC ID 0648177873, 314 clinicians

Practice addresses (Care Compare)

3101 SE 14TH St
Bentonville, AR 72712-4900
Phone (479) 631-2100

Hospital & facility affiliations

  • Mercy Hospital Northwest Arkansas Hospital, Rogers, AR, CCN 040010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
A005115ARMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Northwest Arkansas Communities CurrentSince May 8, 2017 Accepting new patients
Mercy Health Northwest Arkansas Communities CurrentSince May 8, 2017 Accepting new patients
Mercy Northwest Arkansas Ambulatory Services LLC CurrentSince May 11, 2021 Accepting new patients

Locations

4100 SW I St
#200
Bentonville, AR 72713
Phone (479) 268-7640

4100 SW I St
Ste 200
Bentonville, AR 72713
Phone (479) 268-7640

3101 SE 14th St
Bentonville, AR 72712
Phone (479) 631-2100

2012 S Promenade Blvd
Rogers, AR 72758
Phone (479) 616-1485

Interoperability endpoints

  • Direct secure messaging: rrephan113954@directc.mercy.net

Organizations & group practices 3

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1491436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743724800000",
    "number": "1508399502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 SW I ST # 200",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727130200",
            "telephone_number": "479-268-7640",
            "fax_number": "479-250-9817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 SW I ST # 200",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727130200",
            "telephone_number": "479-268-7640",
            "fax_number": "479-250-9817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUBLEY",
        "first_name": "ROSANNA",
        "middle_name": "NICOLE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-06",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A005115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

Verify at the official NPI Registry.