Provider Demographics
NPI:1790393577
Name:ROE, STAR MICHELLE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:STAR
Middle Name:MICHELLE
Last Name:ROE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6171 CHILDERS RD
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1227
Mailing Address - Country:US
Mailing Address - Phone:304-733-5380
Mailing Address - Fax:
Practice Address - Street 1:6171 CHILDERS RD
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1227
Practice Address - Country:US
Practice Address - Phone:304-733-5380
Practice Address - Fax:304-733-5796
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV107018363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily