Provider Demographics
NPI:1770988800
Name:ROACH, KRISTA GAIL (APRN)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:GAIL
Last Name:ROACH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:KRISTA
Other - Middle Name:GAIL
Other - Last Name:HESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:422 HEYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-1346
Mailing Address - Country:US
Mailing Address - Phone:502-636-3133
Mailing Address - Fax:
Practice Address - Street 1:422 HEYWOOD AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-1346
Practice Address - Country:US
Practice Address - Phone:502-636-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009011363LF0000X, 363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100312960Medicaid