Provider Demographics
NPI:1497448666
Name:ROANE, KAYANA
Entity Type:Individual
Prefix:
First Name:KAYANA
Middle Name:
Last Name:ROANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 HULL HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:HEATHSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22473-2821
Mailing Address - Country:US
Mailing Address - Phone:804-724-0498
Mailing Address - Fax:
Practice Address - Street 1:464 HULL HARBOR RD
Practice Address - Street 2:
Practice Address - City:HEATHSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22473-2821
Practice Address - Country:US
Practice Address - Phone:804-724-0498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001231993163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty