Individual
MRS. JODY ANN ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
100 S WHITEWOMAN ST, COSHOCTON, OH 43812-1068
(740) 622-1220
(740) 622-6384
Mailing address
12201 BLUEGRASS PKWY, LOUISVILLE, KY 40299-2361
(502) 568-7364
(502) 568-7136
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
APRN.CNP021356
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0236769
—
OH
01
—
H605201
MEDICARE PTAN
OH
Enumeration date
07/26/2017
Last updated
12/07/2018
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