Provider Demographics
NPI:1801785977
Name:ROACH, MIRIAH ASHLIE (FNP-C)
Entity type:Individual
Prefix:
First Name:MIRIAH
Middle Name:ASHLIE
Last Name:ROACH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 MISSION RANCH BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-5137
Mailing Address - Country:US
Mailing Address - Phone:530-894-0500
Mailing Address - Fax:530-345-2532
Practice Address - Street 1:114 MISSION RANCH BLVD STE 10
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-5137
Practice Address - Country:US
Practice Address - Phone:530-894-0500
Practice Address - Fax:530-345-2532
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95035733363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily