Kelli Rose Roe, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

28181384A Issued in IN

Practice address

4813 New Haven Ave
Fort Wayne, IN 46803-3018

Phone

(260) 449-7504

NPI assigned

Oct 24, 2017

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

Medicare fee-for-service enrollment

Enrolled in IN

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

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kelli.roe.1@14428.direct.athenahealth.com

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.

• Ft. Wayne-Allen County Department of Health

  • Public Health or Welfare Agency
  • Fort Wayne, IN
  • NPI 1649422668
  Medicare reassignment NPD

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

{
    "created_epoch": "1508803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611273600000",
    "number": "1831600311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4813 NEW HAVEN AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468033018",
            "telephone_number": "260-449-7504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4813 NEW HAVEN AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468033018",
            "telephone_number": "260-449-7504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROE",
        "first_name": "KELLI",
        "middle_name": "ROSE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-24",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "28181384A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olivia R Rodriguez, RBT
• Stacy L. Rodriguez, NP
• Vicente A. Rodriguez, MD
• Yilian Rodriguez
• Zhagya Rodriguez
• Ludmila Roebel, NURSE PRACTITIONER
• Ron James Roeble, CTRS
• Austin Roemer, RBT
• Debra Lynn Roesner, LCSW
• Robert D. Roether, MD

• Family Nurse Practitioner in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; 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.