Provider Demographics
NPI:1689627994
Name:ROACH-DAVIS, RAMONA LEIGH (CRNP)
Entity Type:Individual
Prefix:
First Name:RAMONA
Middle Name:LEIGH
Last Name:ROACH-DAVIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3081 LORNA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35216-4509
Mailing Address - Country:US
Mailing Address - Phone:205-979-3381
Mailing Address - Fax:205-979-3726
Practice Address - Street 1:774 SHADES MOUNTAIN PLZ
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-1513
Practice Address - Country:US
Practice Address - Phone:205-979-3381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-096146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891011660Medicaid