Shosty Sue Roth, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10742 Issued in MN

Practice address

2215 S 6TH St
Brainerd, MN 56401-5512

Phone

(218) 454-1010

NPI assigned

Jan 29, 2010

Last updated

Nov 5, 2025By 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 1

Addresses

Other names 1

• Shosty Sue Heyblom Former name

Medicare fee-for-service enrollment

Enrolled in MN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1264723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762300800000",
    "number": "1740511831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 S 6TH ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564015512",
            "telephone_number": "218-454-1010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 S 6TH ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564015512",
            "telephone_number": "218-454-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "SHOSTY",
        "middle_name": "SUE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-29",
        "last_updated": "2025-11-05",
        "certification_date": "2025-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "10742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHOSTY",
            "last_name": "HEYBLOM",
            "middle_name": "SUE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mary Catherine Roesler, RN
• Genevieve Violet Louise Rohde
• Lauren Joy Roos, LMFT
• Amber Rosier, LICSW
• Kayla J Ross, APRN,CRNA
• Lara Royer
• Allen Rud, L.P.T.
• Paul Thomas Rud, MD
• Jordan Rudolph
• Melonee Ruhl, FNP

• Physician Assistant in Brainerd, MN
• Providers in Brainerd, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.