Healthcare Provider Details

I. General information

NPI: 1396651295
Provider Name (Legal Business Name): JOHN DAVID ROTH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 SW LINCOLN ST
TOPEKA KS
66611-2149
US

IV. Provider business mailing address

2200 SW GAGE BLVD
TOPEKA KS
66622-0001
US

V. Phone/Fax

Practice location:
  • Phone: 785-213-2373
  • Fax:
Mailing address:
  • Phone: 785-350-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number13-82991-111
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: