Provider Demographics
NPI:1447227996
Name:ROEDER, KATHLEEN MARIE (MS, ARNP, BC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:ROEDER
Suffix:
Gender:F
Credentials:MS, ARNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10248 ARROW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4305
Mailing Address - Country:US
Mailing Address - Phone:727-375-9361
Mailing Address - Fax:
Practice Address - Street 1:9912 LITTLE RD
Practice Address - Street 2:VA OUTPATIENT CLINIC PASCO
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-3419
Practice Address - Country:US
Practice Address - Phone:727-869-4153
Practice Address - Fax:727-869-4193
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP519902363LA2200X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult