Provider Demographics
NPI:1073571923
Name:ROLLINS, NANCY KATHERINE (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:KATHERINE
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1571 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7655
Mailing Address - Country:US
Mailing Address - Phone:214-926-8780
Mailing Address - Fax:
Practice Address - Street 1:1571 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7655
Practice Address - Country:US
Practice Address - Phone:214-926-8780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG30662085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125398104Medicaid
B49141Medicare UPIN
TX83R937Medicare ID - Type Unspecified