NATHANIEL D ROACH (NPI# 1841421583) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841421583 |
| Entity Type | Individual |
| Full Name | NATHANIEL D ROACH |
| Credential | PA |
| Practice Address |
5050 N Clinton St Fort Wayne IN 46825-5886 |
| Mailing Address |
5052 N Clinton St Fort Wayne IN 46825-5822 |
| Practice Telephone | 2604848551 |
| Practice Fax Number | 2604825060 |
| Mailing Telephone | 2604848551 |
| Mailing Fax Number | 2604825060 |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2018-10-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
10001124A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 300006062 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 11136 Parkview Circle Dr, Fort Wayne, IN 468451730 | 2604848551 | 2604825060 |
| 1500 Provident Dr Ste B, Warsaw, IN 465803297 | 5742698301 | 5742698302 |
| 7920 W Jefferson Blvd, Fort Wayne, IN 468044168 | 2604848551 | 2604825060 |
| 7920 W Jefferson Blvd Ste 100, Fort Wayne, IN 468044166 | 2604848551 | 2604825060 |
| Street Address |
5050 N CLINTON ST |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46825-5886 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144228529 | Scott Davis | Anesthesiology | 5050 N Clinton St, Fort Wayne, IN 46825-5886 | 2005-07-11 |
| 1477179737 | Mirsad Maglajlic | Nurse Anesthetist, Certified Registered | 5050 N Clinton St, Fort Wayne, IN 46825-5886 | 2020-06-23 |
| 1053937961 | Kay Elizabeth Brown | Registered Nurse | 5050 N Clinton St, Fort Wayne, IN 46825-5886 | 2020-06-17 |
| 1831714716 | Raelene Marie Lamott | Licensed Practical Nurse | 5050 N Clinton St, Fort Wayne, IN 46825-5886 | 2020-06-16 |
| 1982184701 | Angela R Kesler | Physical Therapist | 5050 N Clinton St, Fort Wayne, IN 46825-5886 | 2018-08-21 |
| 1912485947 | Kaley Alison Weber | Physician Assistant | 5050 N Clinton St, Fort Wayne, IN 46825-5886 | 2018-08-01 |
| 1275019341 | Cayla Marie Vorndran | Physician Assistant | 5050 N Clinton St, Fort Wayne, IN 46825-5886 | 2018-07-12 |
| 1629560370 | Aaron Michael Lewis | Nurse Anesthetist, Certified Registered | 5050 N Clinton St, Fort Wayne, IN 46825-5886 | 2018-05-30 |
| 1144724402 | Surgery One Anesthesia, LLC | Anesthesiology | 5050 N Clinton St, Fort Wayne, IN 46825-5886 | 2018-03-21 |
| 1235631557 | Samuel Vincent Dismuke | Physician Assistant | 5050 N Clinton St, Fort Wayne, IN 46825-5886 | 2018-03-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336772078 | Bradley Murphy | Occupational Therapist | 2626 St Joe Center Ed, Fort Wayne, IN 46825 | 2020-02-21 |
| 1144851015 | Sabryna Roman | Developmental Therapist | 2626 St Joe Center Rd, Fort Wayne, IN 46825 | 2020-01-30 |
| 1205474103 | Ashleigh Miller | Developmental Therapist | 2626 St. Joe Center Rd, Fort Wayne, IN 46825 | 2019-12-11 |
| 1962055152 | Carehalo Ohio LLC | General Practice | 2510 Dupont Circle Dr., Suite 201, Fort Wayne, IN 46825 | 2019-07-17 |
| 1306318175 | Logan Alan Williams | Nurse Anesthetist, Certified Registered | 10315 Dawsons Creek Blvd Ste B, Fort Wayne, IN 46825 | 2018-12-18 |
| 1326582925 | Mark F Stoner LLC | Dentist | 9830 Auburn Rd Suite 102, Fort Wayne, IN 46825 | 2016-12-15 |
| 1336695782 | Nadine Rene' Handy | Nurse Practitioner | 3978 New Vision Dr., Fort Wayne, IN 46825 | 2016-08-26 |
| 1558815712 | Nathan Paul Miller | Physical Therapist | 10006 Auburn Park Dr, Fort Wayne, IN 46825 | 2016-08-05 |
| 1013366905 | Brianna Abbott | Physician Assistant | 1234 E Dupont Rd Ste 7, Fort Wayne, IN 46825 | 2016-06-10 |
| 1003276643 | Seiss, LLC | Psychologist | 9910 Dupont Circle Drive, Suite 140, Fort Wayne, IN 46825 | 2016-02-24 |
| Find all providers in zip 46825 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144215153 | Mark A Fisher | Physician Assistant | 1721 Magnavox Way, Fort Wayne, IN 46804-1537 | 2005-09-15 |
| 1275142986 | Bradley Ophoff | Physician Assistant | 1819 Carew St, Fort Wayne, IN 46805-4705 | 2020-07-28 |
| 1073963351 | Jenifer Kay Fortney | Physician Assistant | 5650 Coventry Ln, Fort Wayne, IN 46804-7140 | 2016-06-16 |
| 1972900199 | Rachel Mcpherson | Physician Assistant | 7333 W Jefferson Blvd, Fort Wayne, IN 46804-6280 | 2014-12-03 |
| 1730581067 | Keith William Lowe | Physician Assistant | 11109 Parkview Plaza Dr, Fort Wayne, IN 46845-1701 | 2014-09-18 |
| 1528321759 | Sarita Ruetz | Physician Assistant | 11109 Parkview Plaza Dr, Fort Wayne, IN 46845-1701 | 2012-06-21 |
| 1760765945 | Jennifer Raye Myers | Physician Assistant | 7333 W Jefferson Blvd, Fort Wayne, IN 46804-6280 | 2011-09-23 |
| 1265678486 | Cheryl Lynn Kiel | Physician Assistant | 11109 Parkview Plaza Dr, Fort Wayne, IN 46845-1701 | 2008-12-17 |
| 1407010564 | Emily E Lierman | Physician Assistant | 2200 Randallia Dr., Fort Wayne, IN 46805-4638 | 2008-07-17 |
| 1750545414 | Briana Nicole Aspy | Physician Assistant | 11141 Parkview Plaza Dr, Suite 210, Fort Wayne, IN 46845-1713 | 2008-07-11 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46825 |
Please comment or provide details below to improve the information on NATHANIEL D ROACH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.