Provider Demographics
NPI:1790493294
Name:ROACH, ARKENA NICOLE
Entity Type:Individual
Prefix:MS
First Name:ARKENA
Middle Name:NICOLE
Last Name:ROACH
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 1:1131 NATIONAL ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-2028
Mailing Address - Country:US
Mailing Address - Phone:901-283-0285
Mailing Address - Fax:
Practice Address - Street 1:1131 NATIONAL ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-2028
Practice Address - Country:US
Practice Address - Phone:901-283-0285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist