Healthcare Provider Details

I. General information

NPI: 1700720059
Provider Name (Legal Business Name): ROANE PRIMARY CARE AND FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4913 RALEIGH COMMON DR STE 201
MEMPHIS TN
38128-2485
US

IV. Provider business mailing address

4913 RALEIGH COMMON DR STE 201
MEMPHIS TN
38128-2485
US

V. Phone/Fax

Practice location:
  • Phone: 901-692-8014
  • Fax:
Mailing address:
  • Phone: 901-692-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAUNTA LEA ROANE
Title or Position: NURSE PRACTITIONER
Credential: DNP-FNP-C
Phone: 901-692-8014