Provider Demographics
NPI:1215578273
Name:ROACH, BRIANNA CORRINNE (NP)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:CORRINNE
Last Name:ROACH
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:220 CAMPUS BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2889
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:3774 VALLEY RD
Practice Address - Street 2:
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411-4614
Practice Address - Country:US
Practice Address - Phone:304-258-9433
Practice Address - Fax:304-258-6063
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC002811363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care