Jaclyn Roth, LPN is a
Licensed Practical Nurse based in Troy, Illinois. Jaclyn Roth is licensed to practice in Illinois (license number 043119533) and her current practice location is
121 Steven Dr, Troy, Illinois. She can be reached at her office (for appointments etc.) via phone at
(618) 288-3700.
NPI number for Jaclyn Roth is 1548831159 and her current mailing address is 27 Auerbach Pl, Glen Carbon, Illinois. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1548831159.
Provider's Profile
Full Name | Jaclyn Roth |
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Gender | Female |
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Speciality | Licensed Practical Nurse |
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Location | 121 Steven Dr, Troy, Illinois |
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Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
NPI Data:
- NPI Number: 1548831159
- Provider Enumeration Date: 07/06/2021
- Last Update Date: 07/06/2021
Medical Identifiers
Medical identifiers for Jaclyn Roth such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1548831159 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
164W00000X | Licensed Practical Nurse | 043119533 (Illinois) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jaclyn Roth is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Jaclyn Roth, LPN 27 Auerbach Pl, Glen Carbon, IL 62034-1596 Ph: (618) 288-3700 | Jaclyn Roth, LPN 121 Steven Dr, Troy, IL 62294-1866 Ph: (618) 288-3700 |
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