Healthcare Provider Details

I. General information

NPI: 1609214261
Provider Name (Legal Business Name): MEREDITH MARIE ROACHELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 FANNIN ST STE 640
HOUSTON TX
77030-2610
US

IV. Provider business mailing address

842 COASTAL CT
LEAGUE CITY TX
77573-1528
US

V. Phone/Fax

Practice location:
  • Phone: 832-822-3250
  • Fax: 832-825-9070
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number727565
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP123648
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: