Basic Information
| Provider Information | |||||||||
| NPI: | 1407018799 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROATCH | ||||||||
| FirstName: | LAURIE | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | N.P.-B.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8307 KNIGHT RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770543905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132427707 | ||||||||
| FaxNumber: | 7137969779 | ||||||||
| Practice Location | |||||||||
| Address1: | 8307 KNIGHT RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770543905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132427707 | ||||||||
| FaxNumber: | 7137969779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2008 | ||||||||
| LastUpdateDate: | 10/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 693924 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 199607601 | 05 | TX | MEDICAID |