JENNIFER DIANE ROTH (NPI# 1477105427) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477105427 |
| Entity Type | Individual |
| Full Name | JENNIFER DIANE ROTH |
| Credential | FNP-C |
| Practice Address |
624 Old Saint Marys Rd Perryville MO 63775-1837 |
| Mailing Address |
525 Omete Creek Ln Perryville MO 63775-6631 |
| Practice Telephone | 5735473232 |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2019-07-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
2019024741 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306381033 | Jennifer Michelle Roth | Counselor | 6544 Ferguson St, Indianapolis, IN 46220-1178 | 2017-01-04 |
| 1538551700 | Jennifer Nicole Roth | Registered Nurse | 144 Erika Loop, Staten Island, NY 10312-6659 | 2015-02-25 |
| 1346647575 | Jennifer Wynn Roth | Massage Therapist | 2108 Broadwater Ave Ste 202, Billings, MT 59102-4732 | 2014-12-03 |
| 1346556149 | Jennifer Roth | Social Worker | 101 American Center Pl Ste 108, Tampa, FL 33619-4452 | 2010-08-31 |
| 1376543496 | Jennifer Ellen Roth | Physician Assistant | 524 S Washington St, Gettysburg, PA 17325-2594 | 2005-07-29 |
| 1447250733 | Jennifer Elizabeth Roth | Nurse Practitioner | 103 Azalea Way, Marshall, TX 75672-9265 | 2005-07-28 |
| 1205309895 | Jennifer A Roth | Counselor | 9245 Quantrelle Ave Ne, Otsego, MN 55330-0168 | 2019-01-07 |
| 1841735107 | Jennifer Roth | Student in an Organized Health Care Education/Training Program | 4801 Veterans Dr, Saint Cloud, MN 56303-2015 | 2016-12-22 |
| 1689057325 | Jennifer Isabel Roth | Counselor | 2608 Old Fair Rd, Grand Island, NE 68803-5271 | 2015-06-30 |
| 1629476106 | Jennifer Marie Roth | Registered Nurse | 7701 Sheridan Blvd, Westminster, CO 80003-2605 | 2014-12-15 |
| Street Address |
624 OLD SAINT MARYS RD |
| City | PERRYVILLE |
| State | MO |
| Zip Code | 63775-1837 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891726782 | Kathleen M. Arnzen | Nurse Practitioner | 624 Old Saint Marys Rd, Suite A, Perryville, MO 63775-1837 | 2006-07-06 |
| 1700350543 | Southeast Missouri Hospital Physicians, LLC | Clinic/Center | 624 Old Saint Marys Rd, Perryville, MO 63775-1837 | 2019-01-15 |
| 1326593310 | Nikki Marie Malley | Nurse Practitioner | 624 Old Saint Marys Rd, Perryville, MO 63775-1837 | 2016-08-18 |
| 1477909372 | Professional Clinics, LLC | Clinic/Center | 624 Old Saint Marys Rd, Suite A, Perryville, MO 63775-1837 | 2016-05-10 |
| 1326346057 | Gena Marie Weinhold | Nurse Practitioner | 624 Old Saint Marys Rd, A, Perryville, MO 63775-1837 | 2011-03-03 |
| 1275837551 | Michael J Moldenhauer | Nurse Practitioner | 624 Old Saint Marys Rd, Suite A, Perryville, MO 63775-1837 | 2010-12-31 |
| 1154563559 | Professional Clinics LLC | Clinic/Center | 624 Old Saint Marys Rd, Suite A, Perryville, MO 63775-1837 | 2009-03-31 |
| 1427195122 | Gayla Ann Dace | Nurse Practitioner | 624 Old Saint Marys Rd, Suite A, Perryville, MO 63775-1837 | 2007-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144949 | New Life Mission Inn - Missouri | Clinic/Center | 114 W. South, Perryville, MO 63775 | 2020-11-02 |
| 1881211829 | Sarah Jo Cross | Social Worker | 406 S Spring St, Ste 2, Perryville, MO 63775 | 2020-06-25 |
| 1902461908 | Health Care Pharmacy of Perryville, LLC | Pharmacy | 628 N Old St Marys Rd, Perryville, MO 63775 | 2019-05-06 |
| 1710437603 | Danielle Renee Hoeckele | Chiropractor | 1516 Edgemont Blvd Ste 100, Perryville, MO 63775 | 2016-10-04 |
| 1487024956 | Sherry Ann Goshen | Social Worker | 12 N Kings Hwy, Perryville, MO 63775 | 2015-09-28 |
| 1669801353 | Derek Adelman | Physical Therapy Assistant | 206 Hospital Lane, Ste 100, Perryville, MO 63775 | 2013-11-04 |
| 1407158678 | Perry County Memorial Hospital | Ambulance | 434 N West Street, Perryville, MO 63775 | 2010-11-22 |
| 1699928358 | East Missouri Action Agency, Inc. | Clinic/Center | 519 Old St Mary's Rd, Perryville, MO 63775 | 2008-10-28 |
| 1013171115 | Air Evac Ems Inc. | Ambulance | 4801 N Highway 51, Perryville, MO 63775 | 2008-07-17 |
| 1245457241 | Robert Schremp | Physical Therapist | 150 S. Mount Auburn Road, Cape Girardeau, MO 63775 | 2007-04-19 |
| Find all providers in zip 63775 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750931697 | Rachel Dibooglu | Nurse Practitioner | 1400 Old Saint Marys Rd, Perryville, MO 63775-1244 | 2019-09-12 |
| 1417456989 | Dionne H Wallace | Nurse Practitioner | 1016 N Fourche Ave, Perryville, AR 72126-8545 | 2018-02-09 |
| 1528435732 | Stanley Prochaska Jr. | Nurse Practitioner | 1 Avenue D, Perryville, MD 21902 | 2015-08-24 |
| 1699930834 | Leticia M. Kelley | Nurse Practitioner | 212 Hospital Ln Ste 101, Perryville, MO 63775-4204 | 2008-07-28 |
| 1891726782 | Kathleen M. Arnzen | Nurse Practitioner | 624 Old Saint Marys Rd, Suite A, Perryville, MO 63775-1837 | 2006-07-06 |
| 1124642764 | Brooke Elizabeth Hotop | Nurse Practitioner | 212 Hospital Ln Ste 101, Perryville, MO 63775-4204 | 2020-05-29 |
| 1598316564 | Angela Kay Wright | Nurse Practitioner | 1314 Brenda Ave, Perryville, MO 63775-2303 | 2019-09-21 |
| 1336640127 | Megan Andres | Nurse Practitioner | 1016 North Fourche Avenue, Perryville, AR 72126-7257 | 2018-02-27 |
| 1417456443 | Rainie Jones | Nurse Practitioner | 518 N Fourche Ave, Perryville, AR 72126-9701 | 2018-02-05 |
| 1003322009 | Bayley Nicole Little | Nurse Practitioner | 1508 Edgemont Blvd, Perryville, MO 63775-1231 | 2017-12-28 |
| Find all providers in PERRYVILLE | ||||
| City | PERRYVILLE |
| Zip Code | 63775 |
Please comment or provide details below to improve the information on JENNIFER DIANE ROTH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.