Individual
MS. JENICE DIANE PALACHICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
4035 ELECTRIC RD STE A, ROANOKE, VA 24018-8449
(540) 772-8670
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
SP010477
PA
363LF0000X
Family Nurse Practitioner
Primary
0024185916
VA
363LF0000X
Family Nurse Practitioner
SP010477
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007307260034
MEDICAID GROUP #
PA
05
—
102416560 0001
—
PA
01
—
25-1716306
HEALTHNET/TRICARE
PA
01
—
50090234
CAPITAL BLUECROSS
PA
05
—
541024000
—
MD
01
—
679M
MEDICARE GROUP #
MD
01
—
867633
MEDICARE GROUP #
PA
01
—
P00802876
RAILROAD MEDICARE
PA
01
—
SP010477
LICENSE
PA
Enumeration date
11/20/2009
Last updated
09/19/2025
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