Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 58642 | TN |
N | 208600000X | Surgeon | 58642 | TN |
Y | 2086S0102X | Surgical Critical Care | 58642 | TN |
N | 2086S0127X | Trauma Surgeon | 58642 | TN |
NPI | 1083956486 |
---|---|
Provider Name | Dr. Keelin Flannery Roche |
First Address | Johnson City, TN 37604-2579 |
Second Address | Nashville, TN 37232-2635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2013 |
Last Update Date | 30/12/2020 |