Provider Demographics
NPI:1780789438
Name:RHODES, ROBERTA M (ARNP)
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:M
Last Name:RHODES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:R
Other - Last Name:MCCONVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3706 SW 6TH AVE
Mailing Address - Street 2:STORMONT-VAIL WEST
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2084
Mailing Address - Country:US
Mailing Address - Phone:785-270-4630
Mailing Address - Fax:785-270-4628
Practice Address - Street 1:3706 SW 6TH AVE
Practice Address - Street 2:STORMONT-VAIL WEST
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2084
Practice Address - Country:US
Practice Address - Phone:785-270-4630
Practice Address - Fax:785-270-4628
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSRN-13-38358-101163W00000X
KSARNP 74314363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100251470AMedicaid
KS100251470FMedicaid
KS110661008OtherMEDICARE PTAN
KSRH013257Medicare ID - Type Unspecified
KS100251470AMedicaid