Provider Demographics
NPI:1740218262
Name:ROOP, NANCY L (APRN)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:L
Last Name:ROOP
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 1:7329 N WOODLAWN ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67147-8560
Mailing Address - Country:US
Mailing Address - Phone:316-219-3571
Mailing Address - Fax:316-219-3573
Practice Address - Street 1:331 S HYDRAULIC ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-1908
Practice Address - Country:US
Practice Address - Phone:316-219-3571
Practice Address - Fax:316-219-3573
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44194363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA351011OtherMEDICARE
KS201155050AMedicaid