Individual
MRS. KATIE G. ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
1819 MARSHALL ST, COLUMBIA, SC 29203-6907
(803) 434-7000
Mailing address
709 MOTLEY RD, HOPKINS, SC 29061-9635
(803) 776-6342
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
949
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000
DO NOT HAVE MEDICAID OR MEDICARE ID #
SC
Enumeration date
06/02/2008
Last updated
06/02/2008
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