Provider Demographics
NPI:1548361991
Name:ROY, MARY L (APRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:ROY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 SW 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1535
Mailing Address - Country:US
Mailing Address - Phone:785-354-6773
Mailing Address - Fax:
Practice Address - Street 1:1414 SW 8TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1535
Practice Address - Country:US
Practice Address - Phone:785-354-6773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-45636363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200282590AMedicaid
580690OtherFIRSTGUARD HEALTH PLAN
161346OtherBLUE CROSS BLUE SHIELD KS
KS200282590CMedicaid
161346OtherBLUE CROSS BLUE SHIELD KS
KS200282590AMedicaid
KS200282590CMedicaid