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General NPI Number Information
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NPI Number | 1871447359
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Entity Type | Individual
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Provider Name | PETE ADAM ROACH FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 02/23/2026
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Last Update Date | 02/23/2026
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Provider Practice Location Address
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Address Line | 1655 E GREENVILLE ST
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City | ANDERSON
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State | SC
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Zip | 29621-2062
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Country | US
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Telephone | 864-512-6041
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Fax |
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Provider Business Mailing Address
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Address Line | 2514 ELBERTON HWY
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City | IVA
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State | SC
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Zip | 29655-9322
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Country | US
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Telephone |
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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 | 31587
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License Number State | SC
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