Provider Demographics
NPI:1427648773
Name:ROACH, KATHERINE CHRISTINE (AGACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:CHRISTINE
Last Name:ROACH
Suffix:
Gender:F
Credentials:AGACNP-BC
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 11768
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-0168
Mailing Address - Country:US
Mailing Address - Phone:804-458-8583
Mailing Address - Fax:804-541-2724
Practice Address - Street 1:1012 WINSTON CHURCHILL DR
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-5141
Practice Address - Country:US
Practice Address - Phone:804-458-8583
Practice Address - Fax:804-541-2724
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180800363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care