Provider Demographics
NPI:1669554358
Name:ROE, CHRISTOPHER C (NP)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:C
Last Name:ROE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9134
Mailing Address - Country:US
Mailing Address - Phone:214-648-2277
Mailing Address - Fax:214-645-9976
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9134
Practice Address - Country:US
Practice Address - Phone:214-648-2277
Practice Address - Fax:214-645-9976
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1009118163W00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1669554358Medicaid
DE1669554358Medicaid