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General NPI Number Information
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NPI Number | 1336761253
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Entity Type | Individual
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Provider Name | TABITHA LOUISE ROACH APRN
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Gender | Female
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 200 BRULE ST
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City | FORT KNOX
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State | KY
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Zip | 40121-6100
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Country | US
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Telephone | 502-626-9891
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Fax | 502-626-6140
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Provider Business Mailing Address
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Address Line | 200 BRULE ST
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City | FORT KNOX
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State | KY
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Zip | 40121-6100
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Country | US
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Telephone | 502-626-9891
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Fax | 502-626-6140
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71012162A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 3015334
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 1136348
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License Number State | KY
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