Provider Demographics
NPI:1366849101
Name:ROE, ELIZABETH CROSS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:CROSS
Last Name:ROE
Suffix:
Gender:F
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 1:2017 RICKETY LN
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1706
Mailing Address - Country:US
Mailing Address - Phone:903-533-8811
Mailing Address - Fax:
Practice Address - Street 1:2017 RICKETY LN
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1706
Practice Address - Country:US
Practice Address - Phone:903-533-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical