Roach, Leasa L

Roach, Leasa L is an individual health care provider with primary practice located at 1205 E 35Th St , Texarkana AR 71854-2746. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Gerontology, which is considered as her primary health care specialty. Roach, Leasa L can be contacted via phone (903) 735-5355.

Contact Information

Primary practice address
1205 E 35Th St Texarkana AR 71854-2746
Phone: (903) 735-5355
Fax: (903) 735-5399
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X 526631 Texas

Profile Details

NPI number 1326061235
LBN Legal business name Roach, Leasa L
Credentials Gerontological Nurse Practitioner (GNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 25th, 2006
Last updated Sep 13th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326061235 NPPES
Texas Other 526631 LICENSE
Texas MEDICAID 163821758 LICENSE
Texas Other 8Y1726 LICENSE
Texas Other 5A158 LICENSE
Texas Other P00376988 LICENSE

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