Provider Demographics
NPI:1891954590
Name:ROMAN, TRISHA KENNEDY (MSN, FNP-BC, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:KENNEDY
Last Name:ROMAN
Suffix:
Gender:F
Credentials:MSN, FNP-BC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WESTPARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3537
Mailing Address - Country:US
Mailing Address - Phone:770-450-1245
Mailing Address - Fax:
Practice Address - Street 1:200 WESTPARK DR STE 200
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3537
Practice Address - Country:US
Practice Address - Phone:770-450-1245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN190959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily