Healthcare Provider Details

I. General information

NPI: 1366906042
Provider Name (Legal Business Name): TIMOTHY LEE ROESER DNP APRN NP--C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2019
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 NW 3RD ST
ABILENE KS
67410-2628
US

IV. Provider business mailing address

103 NW 3RD ST
ABILENE KS
67410-2628
US

V. Phone/Fax

Practice location:
  • Phone: 785-458-6343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number53-79973-082
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2013041956
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-97312-082
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-79973-082
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: