Individual
MRS. WANTINA WYNETTE BROOKS-ROACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPM
Contact information
Practice address
10 GIRARD ST STE B, FLORENCE, KY 41042-5106
(859) 363-6050
Mailing address
1141 N LOOP 1604 E # 105187, SAN ANTONIO, TX 78232-1339
(805) 738-8824
(866) 399-0991
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
9000017
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9000017
KENTUCKY MIDWIFE LICENSE
KY
Enumeration date
03/05/2007
Last updated
11/27/2020
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