Provider Demographics
NPI:1003391160
Name:ROKS, AMY J (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:ROKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:J
Other - Last Name:RATLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2449 HOSPITAL DR STE 210
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-1906
Mailing Address - Country:US
Mailing Address - Phone:318-212-7280
Mailing Address - Fax:318-212-7278
Practice Address - Street 1:2449 HOSPITAL DR STE 210
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-1906
Practice Address - Country:US
Practice Address - Phone:318-212-7280
Practice Address - Fax:318-212-7278
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2485695Medicaid