Individual provider Active NPI

Katelyn Rossow, MD

  • Developmental - Behavioral Pediatrics Physician
  • Jackson, MS
National Provider Identifier
1790102788
Registry record updated Jul 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
License
55729 Issued in KY
Practice address
2500 N State St
Jackson, MS 39216-4500
Phone
(502) 588-0850
NPI assigned
Mar 27, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2025

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 55729 KY
Pediatrics Physician 208000000X 01079254A IN
Developmental - Behavioral Pediatrics Physician 2080P0006X 01079254A IN
Developmental - Behavioral Pediatrics Physician 2080P0006X 56397 TN
Developmental - Behavioral Pediatrics Physician 2080P0006X 55729 KY Primary

Addresses

Primary practice location

2500 N State St
Jackson, MS 39216-4500

Mailing address

2500 N State St
Jackson, MS 39216-4500

Other practice location 1

2200 Children's Way
Monroe Carell Jr. Children's Hospital at Vanderbilt
Nashville, TN 37232
Phone (615) 322-3000

Other practice location 2

3601 The Vanderbilt Clinic
Nashville, TN 37232-0001
Phone (615) 322-3000

Other identifiers 1

IdentifierTypeStateIssuer
7100660090MedicaidKY

Other names 1

  • Katelyn Neely Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kneely29833@direct.vumc.org Direct
Direct Messaging Address katelyn.rossow@nortonhealthcare.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, ID, MS3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20211228000262 KY Practitioner - Pediatric Medicine 8022432178 Reassigns benefits to 1 organization
I20250623003647 ID Practitioner - Pediatric Medicine 8022432178 Reassigns benefits to 1 organization
I20260203003226 MS Practitioner - Pediatric Medicine 8022432178 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
University of Louisville School of Medicine, 2014
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

200 W Martin Luther King Blvd
Suite 1000
Chattanooga, TN 37402-2571

PO Box
Suite 11407
Birmingham, AL 35246

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
55729KYMDPediatrics Physician
01079254AINMDDevelopmental - Behavioral Pediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Norton Children'S Medical Group, LLC Pediatrics CurrentSince Jan 1, 2022 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Jan 1, 2026 Accepting new patients
Norton Children'S Medical Group, LLC CurrentSince Jan 1, 2022 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Jan 1, 2026 Accepting new patients
St Lukes Clinic-Treasure Valley LLC Pediatrics CurrentSince Jun 10, 2025 Accepting new patients
Norton Children'S Medical Group, LLC Current Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

3525 E Louise Dr
Ste 250
Meridian, ID 83642
Phone (208) 381-7312

601 S Floyd St
Ste 604
Louisville, KY 40202
Phone (502) 559-1670

1405 E Burnett Ave
Louisville, KY 40217
Phone (502) 473-7219

411 E Chestnut St
Louisville, KY 40202
Phone (502) 588-2330

4400 Old Canton Rd
Ste 3RD
Jackson, MS 39211

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

Interoperability endpoints

  • Direct secure messaging: krossow224284@direct.nortonhealthcare.org

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1395878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752537600000",
    "number": "1790102788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "502-588-0850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2200 Children's Way",
            "address_2": "Monroe Carell Jr. Children's Hospital at Vanderbilt",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "37232",
            "country_code": "US",
            "telephone_number": "615-322-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3601 The Vanderbilt Clinic",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372320001",
            "country_code": "US",
            "telephone_number": "615-322-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSSOW",
        "first_name": "KATELYN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-27",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "55729",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01079254A",
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "IN",
            "license": "01079254A",
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "TN",
            "license": "56397",
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "KY",
            "license": "55729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100660090",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kneely29833@direct.vumc.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Health Information Service Provider",
            "address_1": "2200 Children's Way",
            "address_2": "Monroe Carell Jr. Children's Hospital at Vanderbilt",
            "city": "Nashville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "37232",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "katelyn.rossow@nortonhealthcare.org",
            "affiliation": "N",
            "address_1": "411 E Chestnut St",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402021713",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KATELYN",
            "last_name": "NEELY",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.