Active NPI
Katherine Susanne Rollins, PSYD
- Psychologist
- Kernersville, NC
National Provider Identifier
1831265370
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2901
- Practice address
- 851 Old Winston Rd
Suite 107
Kernersville, NC 27284-8780 - Phone
- (336) 992-2171
- NPI assigned
- Nov 27, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2901 | NC | Primary |
Addresses
Primary practice location
851 Old Winston Rd
Suite 107
Kernersville, NC 27284-8780
Mailing address
851 Old Winston Rd
Suite 107
Kernersville, NC 27284-8780
Phone (336) 992-2171
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6000919 | Medicaid | NC | |
| 2901 | Other | NC | PSYCHOLOGY BOARD LICENSE |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901 | NC | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cornerstone Health Care, PA | Past | Accepting new patients | |
| Wake Forest Health Network, LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358294400000",
"number": "1831265370",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "851 OLD WINSTON RD",
"address_2": "SUITE 107",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "272848780",
"telephone_number": "336-992-2171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "851 OLD WINSTON RD",
"address_2": "SUITE 107",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "272848780",
"telephone_number": "336-992-2171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROLLINS",
"first_name": "KATHERINE",
"middle_name": "SUSANNE",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-27",
"last_updated": "2013-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "2901",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6000919",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGY BOARD LICENSE",
"identifier": "2901",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kernersville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.