Individual
LEISA JOAN ROAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2539 VIKING DR STE 100, BOSSIER CITY, LA 71111-1611
(318) 747-8105
(318) 747-8150
Mailing address
2539 VIKING DR STE 101, BOSSIER CITY, LA 71111-2165
(318) 747-8100
(318) 747-8150
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
214754
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023205
—
LA
Enumeration date
09/17/2020
Last updated
04/08/2021
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