Provider Demographics
NPI:1447215066
Name:ROELKE, JAMES C (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:ROELKE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:628 HOSPITAL DR
Mailing Address - Street 2:GROUND FLOOR, SUITE A
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2953
Mailing Address - Country:US
Mailing Address - Phone:870-425-4402
Mailing Address - Fax:870-424-3089
Practice Address - Street 1:628 HOSPITAL DR
Practice Address - Street 2:GROUND FLOOR, SUITE A
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2953
Practice Address - Country:US
Practice Address - Phone:870-425-4402
Practice Address - Fax:870-424-3089
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPA-136OtherLICENSE
ARS71529Medicare UPIN