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General NPI Number Information
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NPI Number | 1851950364
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Entity Type | Individual
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Provider Name | JUSTIN T ROACH APRN, NP-C
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Gender | Male
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Dates
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Enumeration Date | 06/08/2019
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 204 S MAIN ST
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City | YATES CENTER
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State | KS
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Zip | 66783-1444
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Country | US
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Telephone | 620-625-2746
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Fax | 888-802-7094
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Provider Business Mailing Address
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Address Line | 3015 N MICHIGAN ST
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City | PITTSBURG
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State | KS
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Zip | 66762-2546
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Country | US
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Telephone | 620-240-5607
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 53-78756-082
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License Number State | KS
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