Provider Demographics
NPI:1962888107
Name:ROACH, JESSICA ANNE (ACPNP)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:ANNE
Last Name:ROACH
Suffix:
Gender:F
Credentials:ACPNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:BEATY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:MLC 11024
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-803-4724
Mailing Address - Fax:513-803-9294
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:MLC 11024
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-803-4724
Practice Address - Fax:513-803-9294
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.17804-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics