Renee Ann Roth, NP
Individual provider Active NPI Family Nurse Practitioner · Columbus, KS
NPI 1831829068 · NPPES record last updated Sep 18, 2023
Key facts
- NPI
- 1831829068
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 53-82256-022 (KS)
- Practice address
- 915 W Maple St
Columbus, KS 66725-1508 - Phone
- (471) 310-9286
- NPI assigned
- Jun 11, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231206001236 | KS | Practitioner - Nurse Practitioner | 3375992142 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14-150198-022 | KS | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Signify Health Medical Associates of Kansas LLC | Current |
Accepting new patients |
Locations
4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 14-150198-022 | KS | |
| Family Nurse Practitioner | 363LF0000X | 53-82256-022 | KS | Yes |
Addresses
Primary practice location
915 W Maple St
Columbus, KS 66725-1508
Mailing address
2699 NE Lawton Rd
Columbus, KS 66725-2078
Phone (620) 762-1081
Other practice location 1
2699 NE Lawton Rd
Columbus, KS 66725-2078
Phone (620) 762-1081
Other providers in Columbus, KS
- Mnmch, Inc.
- Nicholas Porter
- Katie Rennie
- Robert D. Herron Jr. DDS PA
- Suzanne Lynn Robinson
- David R Schoech
- St. John'S Medical Group
- The Max Therapy Center, LLC
- William Tucker
- Sarah Jane Tyree
All providers in Columbus, KS · Family Nurse Practitioner in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.