Healthcare Provider Details

I. General information

NPI: 1285237552
Provider Name (Legal Business Name): ALICE A ROQUE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 E STATE ST STE 200
COLUMBUS OH
43215-0109
US

IV. Provider business mailing address

1719 NAPOLEON AVE
NEW ORLEANS LA
70115-4809
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax:
Mailing address:
  • Phone: 504-610-7979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number215813
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: