Provider Demographics
NPI:1669134409
Name:ROCHA, KEILA JUANA (NP)
Entity type:Individual
Prefix:
First Name:KEILA
Middle Name:JUANA
Last Name:ROCHA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 COUNTY ROAD 332
Mailing Address - Street 2:
Mailing Address - City:BERTRAM
Mailing Address - State:TX
Mailing Address - Zip Code:78605-4399
Mailing Address - Country:US
Mailing Address - Phone:915-356-4461
Mailing Address - Fax:
Practice Address - Street 1:1401 MAX COPELAND DR
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-4665
Practice Address - Country:US
Practice Address - Phone:830-693-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1025411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily