Provider Demographics
NPI:1285681619
Name:VAN ROEKEL, MARYBETH (ARNP)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:VAN ROEKEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 HIGHWAY 183
Mailing Address - Street 2:P.O. BOX 547
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:67661-2549
Mailing Address - Country:US
Mailing Address - Phone:785-543-5211
Mailing Address - Fax:785-543-5274
Practice Address - Street 1:214 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:KS
Practice Address - Zip Code:67646-9764
Practice Address - Country:US
Practice Address - Phone:785-689-4220
Practice Address - Fax:785-689-4219
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44437363LF0000X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS101941OtherBC/BS PROVIDER NUMBER
KS100281250BMedicaid
KS100281250BMedicaid
KS1285681619Medicare PIN