Provider Demographics
NPI:1194876649
Name:ROLEN, JOANNA GAYLE (PA-C)
Entity type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:GAYLE
Last Name:ROLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:SKYLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28776-1810
Mailing Address - Country:US
Mailing Address - Phone:828-575-2644
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE B332
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2571
Practice Address - Country:US
Practice Address - Phone:972-566-7788
Practice Address - Fax:972-566-8837
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01711363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX408121ZM3LOtherMEDICARE PTAN
TXTXB115001OtherMEDICARE PTAN
TX408121ZM3JOtherMEDICARE PTAN
TXTXB115000OtherMEDICARE PTAN
TX8L5491Medicare PIN
TXTXB115001OtherMEDICARE PTAN
TX8L5607Medicare PIN