Individual provider Active NPI

Rose Michelle Kerry

  • Case Manager/Care Coordinator
  • Alexandria, LA
National Provider Identifier
1730660812
Registry record updated Aug 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Practice address
1450 Peterman Dr Ste a
Alexandria, LA 71301-3432
Phone
(318) 473-4328
Fax
(318) 473-4329
NPI assigned
Aug 27, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X Primary

Addresses

Primary practice location

1450 Peterman Dr Ste a
Alexandria, LA 71301-3432

Mailing address

2525 Youree Dr Ste 110
Shreveport, LA 71104-3600
Phone (318) 675-0804

Other names 1

  • Mrs. Rose Michelle Wyll Former name

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

Practice roles

OrganizationSpecialtyStatusNew patients
Rehab Services of Cenla PastSince Jul 31, 2023 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1535328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535328000000",
    "number": "1730660812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 YOUREE DR STE 110",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711043600",
            "telephone_number": "318-675-0804",
            "fax_number": "318-425-9030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 PETERMAN DR STE A",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713013432",
            "telephone_number": "318-473-4328",
            "fax_number": "318-473-4329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERRY",
        "first_name": "ROSE",
        "middle_name": "MICHELLE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-27",
        "last_updated": "2018-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROSE",
            "last_name": "WYLL",
            "middle_name": "MICHELLE",
            "prefix": "MRS.",
            "credential": "BA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Alexandria, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2018; 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.