Healthcare Provider Details

I. General information

NPI: 1134008832
Provider Name (Legal Business Name): KYLE ROANHOUSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 N POINTE DR
DURHAM NC
27705-3405
US

IV. Provider business mailing address

1510 N POINTE DR
DURHAM NC
27705-3405
US

V. Phone/Fax

Practice location:
  • Phone: 919-220-2770
  • Fax:
Mailing address:
  • Phone: 919-220-2770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1680
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: