Provider Demographics
NPI:1740680776
Name:ROACHE, TERESA N
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:N
Last Name:ROACHE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 AMERICAN WAY STE 3
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-5882
Mailing Address - Country:US
Mailing Address - Phone:423-543-4696
Mailing Address - Fax:
Practice Address - Street 1:1905 AMERICAN WAY STE 3
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5882
Practice Address - Country:US
Practice Address - Phone:423-543-4696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184633363LF0000X
TN18731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily