Individual
LEASA L ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GNP
Contact information
Practice address
2407 GALLERIA OAKS DR, TEXARKANA, TX 75503-4676
(903) 794-4263
(430) 200-4677
Mailing address
1205 E 35TH ST, TEXARKANA, AR 71854-2746
(903) 835-5355
(903) 735-5399
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
114559
TX
363LG0600X
Gerontology Nurse Practitioner
526631
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163821758
—
AR
01
—
526631
LICENSE
TX
01
—
5A158
BLUECROSS BLUESHIELD
AR
01
—
8Y1726
BLUE CROSS BLUE SHIELD
TX
01
—
P00376988
RAILROAD MEDICARE
TX
Enumeration date
07/25/2006
Last updated
12/29/2025
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