Individual
KRISTINA O ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1870 AMHERST ST STE 2B, WINCHESTER, VA 22601-2841
(540) 536-2790
(540) 536-2791
Mailing address
220 CAMPUS BLVD STE 100, WINCHESTER, VA 22601-2896
(540) 536-5100
(540) 536-0235
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110840646
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007008S71
MEDICARE PIN (OLD)
VA
05
—
1346200896
—
VA
01
—
P00734696
MEDICARE RR
VA
Enumeration date
03/27/2006
Last updated
11/25/2020
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