MEDICARE: VERNA JEWEL ROACH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle	L127081001	MO

General Provider Information

NPI Number	:	1033079223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERNA JEWEL ROACH

Provider Business Mailing Address
First Line	:	503 CROMWELL RD
Second Line	:
City	:	FESTUS
State	:	MO
Zip	:	63028-1657
Country	:	US
Telephone Number	:	636-208-6474
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 CROMWELL RD
Second Line	:
City	:	FESTUS
State	:	MO
Zip	:	63028-1657
Country	:	US
Telephone Number	:	636-208-6474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2025
Last Update Date	:	12/09/2025

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Directions to “ VERNA JEWEL ROACH ” Practice Location

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