Provider Demographics
NPI:1093748303
Name:ROUCHARD, JOHN S (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:ROUCHARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-5616
Mailing Address - Fax:
Practice Address - Street 1:333 GASHES CREEK RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-9405
Practice Address - Country:US
Practice Address - Phone:828-298-0333
Practice Address - Fax:828-298-0050
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102762363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP01285785OtherRR MEDICARE
NCP01285785OtherRR MEDICARE
S62090Medicare UPIN