MEDICARE: ROOTS AND ROADS CLINICAL SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1306791421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOTS AND ROADS CLINICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	600 S MAIN ST STE 105
Second Line	:
City	:	OSHKOSH
State	:	WI
Zip	:	54902-6074
Country	:	US
Telephone Number	:	920-981-8610
Fax Number	:	920-567-3971

Provider Business Practice Location Address
First Line	:	600 S MAIN ST STE 105
Second Line	:
City	:	OSHKOSH
State	:	WI
Zip	:	54902-6074
Country	:	US
Telephone Number	:	920-981-8610
Fax Number	:	920-567-3971

Authorized Official
Title or Position	:	OWNER
Name	:	KATHERINE MICHELLE MEINE
Credential	:	DNP, PMHNP, CNM,APNP
Telephone Number	:	920-981-8610

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	06/02/2026

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