Provider Demographics
NPI:1396130605
Name:ROEHL, ROXANE ALEXIS DALKE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ROXANE
Middle Name:ALEXIS DALKE
Last Name:ROEHL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ROXANE
Other - Middle Name:ALEXIS
Other - Last Name:DALKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8501 ROLLING GREEN WAY
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-6229
Mailing Address - Country:US
Mailing Address - Phone:520-991-4824
Mailing Address - Fax:
Practice Address - Street 1:10652 S EASTERN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4952
Practice Address - Country:US
Practice Address - Phone:702-476-2800
Practice Address - Fax:702-476-2040
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0008924363A00000X
NVPA1625363AM0700X, 363A00000X
CAPA62121363A00000X
UT13247622-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical