Individual
MS. JOANNA GAYLE ROLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7777 FOREST LN, SUITE B332, DALLAS, TX 75230-2571
(972) 566-7788
(972) 566-8837
Mailing address
PO BOX 1810, SKYLAND, NC 28776-1810
(828) 575-2644
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01711
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
408121ZM3J
MEDICARE PTAN
TX
01
—
408121ZM3L
MEDICARE PTAN
TX
01
—
TXB115000
MEDICARE PTAN
TX
01
—
TXB115001
MEDICARE PTAN
TX
Enumeration date
01/12/2007
Last updated
11/17/2015
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