Provider Demographics
NPI:1659245140
Name:GILLIS, ROANNA LANE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:ROANNA
Middle Name:LANE
Last Name:GILLIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2778 MULE STOMP RD
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-0650
Mailing Address - Country:US
Mailing Address - Phone:540-577-9645
Mailing Address - Fax:
Practice Address - Street 1:23 W MARSHALL ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3298
Practice Address - Country:US
Practice Address - Phone:850-938-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCGILL-9F9UT363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily