Provider Demographics
NPI:1003889965
Name:ROACH, PAULA BETH (RN CNNP)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:BETH
Last Name:ROACH
Suffix:
Gender:F
Credentials:RN CNNP
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:4304 CRICKLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2405
Mailing Address - Country:US
Mailing Address - Phone:910-671-9289
Mailing Address - Fax:
Practice Address - Street 1:BLDG 4-2817 REILLY ROAD
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-7626
Practice Address - Fax:910-907-8645
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC930054363LN0005X, 363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care