=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972412534
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTIN MICHELLE ROTHERMEL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2026
-----------------------------------------------------
Last Update Date | 09/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2050 LEXINGTON RD
-----------------------------------------------------
City | VERSAILLES
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40383-1738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-440-9924
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10697 HOOVER RD
-----------------------------------------------------
City | ROCK FALLS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61071-9105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-440-9924
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 041.498506
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------