Healthcare Provider Details

I. General information

NPI: 1558017814
Provider Name (Legal Business Name): JOHN ROCHEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 VALLEYGATE DR
FAYETTEVILLE NC
28304-3745
US

IV. Provider business mailing address

2041 VALLEYGATE DR
FAYETTEVILLE NC
28304-3745
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-5203
  • Fax: 910-323-3650
Mailing address:
  • Phone: 910-323-5203
  • Fax: 910-323-3650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-12029
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: