MEDICARE: REAGAN ROACH APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	1179532	TX

General Provider Information

NPI Number	:	1750106951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REAGAN ROACH APRN

Provider Business Mailing Address
First Line	:	377 MORGAN AVE
Second Line	:
City	:	PARIS
State	:	TX
Zip	:	75462-2540
Country	:	US
Telephone Number	:	903-517-8201
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 MEDICAL CIR
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-2138
Country	:	US
Telephone Number	:	903-885-1770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2024
Last Update Date	:	04/10/2026

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