Basic Information
| Provider Information | |||||||||
| NPI: | 1780789438 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RHODES | ||||||||
| FirstName: | ROBERTA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCCONVILLE | ||||||||
| OtherFirstName: | ROBERTA | ||||||||
| OtherMiddleName: | R | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3706 SW 6TH AVE | ||||||||
| Address2: | STORMONT-VAIL WEST | ||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666062084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852704630 | ||||||||
| FaxNumber: | 7852704628 | ||||||||
| Practice Location | |||||||||
| Address1: | 3706 SW 6TH AVE | ||||||||
| Address2: | STORMONT-VAIL WEST | ||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666062084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852704630 | ||||||||
| FaxNumber: | 7852704628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 03/02/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN-13-38358-101 | KS | N | Nursing Service Providers | Registered Nurse | 363LP0808X | ARNP 74314 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 100251470A | 05 | KS | MEDICAID | 100251470F | 05 | KS | MEDICAID | 110661008 | 01 | KS | MEDICARE PTAN | OTHER |