Rolla Dermatology LLC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Legal business name

ROLLA DERMATOLOGY LLC

Practice address

1312 E State Hwy 72
Rolla, MO 65401-3939

Phone

(573) 426-4112

NPI assigned

Jul 9, 2024

Last updated

Jul 22, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Darrin Taylor, PA-CNPI 1447368121

Title

Manager

Phone

(417) 766-2043

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Darrin Taylor, PA-C

  • Medical Physician Assistant
  • Rolla, MO
  • NPI 1447368121
  Medicare reassignment Care Compare group Authorized official
• Laura W. Taylor, PA

  • Physician Assistant
  • Rolla, MO
  • NPI 1114284759
  Medicare reassignment Care Compare group
• Kristina R Grant, DO

  • Family Medicine Physician
  • Houston, MO
  • NPI 1356922298
  Medicare reassignment NPD

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

{
    "created_epoch": "1720483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721606400000",
    "number": "1619714425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13109 STERLING HILLS DR",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654016644",
            "telephone_number": "417-766-2043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1312 E STATE HWY 72",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654013939",
            "telephone_number": "573-426-4112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROLLA DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-09",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "DARRIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "417-766-2043",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Casey J Robertson, ATC, LAT
• Mary Kathleen Robinson-Black, L.P.C.
• Shannon Liane Robinson, M.D.
• Cathleen E Rodriguez, LPC
• Rolla Children's Clinic, P.C.
• Rolla Family Dentistry Inc
• Rolla Grand LLC
• Rolla Health Care LLC (Rolla Health & Rehabilitation Suites)
• Rolla Manor, Inc. (Rolla Manor Care Center)
• Rolla Neurology, Pain & Sleep, LLC

• Medical Physician Assistant in Rolla, MO
• Providers in Rolla, MO by specialty
• Medical Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.