Provider Demographics
NPI:1225645393
Name:ROZELL, CARLEE
Entity Type:Individual
Prefix:
First Name:CARLEE
Middle Name:
Last Name:ROZELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12411 W 70TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-2674
Mailing Address - Country:US
Mailing Address - Phone:417-207-2004
Mailing Address - Fax:
Practice Address - Street 1:2522 EQUINE VALLEY RD
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-6101
Practice Address - Country:US
Practice Address - Phone:417-207-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS79704363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner