SHELLY LEE ROARK


Address: 103 S 12th Ave, Laurel, MS 39440-4322
Phone: 6013991970

SHELLY LEE ROARK (NPI# 1083170559) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1083170559
Entity Type Individual
Full Name SHELLY LEE ROARK
Credential NURSE PRACTITIONER
Practice Address 103 S 12th Ave
Laurel
MS 39440-4322
Mailing Address 117 S 11th Ave
Laurel
MS 39440-4312
Practice Telephone 6013991970
Mailing Telephone 6014253033
Mailing Fax Number 6014220431
Enumeration Date 2019-02-20
Last Update Date 2019-02-20
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LW0102X Nurse Practitioner
Specialization: Women's Health
902947 MS Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
MS PENDING 05

Office Location

Street Address 103 S 12TH AVE
City LAUREL
State MS
Zip Code 39440-4322

Providers in the same location

NPI Name Taxonomy Address Enumeration
1073051892 Carol Richardson Family Medicine 103 S 12th Ave, Laurel, MS 39440-4322 2017-02-01

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1306323159 Tender Loving Care Homecare LLC Homemaker 509 Central Ave Ste 224, Laurel, MS 39440 2018-07-24
1669837910 Laurel Dental Properties Dentist 1925 Pine Belt Drive, Laurel, MS 39440 2015-12-30
1215282991 South Central Regional Medical Center Clinic/Center 525 Wayne Drive, Laurel, MS 39440 2012-07-18
1568721215 Terry Ratcliff Perkins Counselor 5192 Hwy 11 North, Laurel, MS 39440 2012-05-15
1437453057 Alexander Milne Home for Women Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 616 East 19th Street, Laurel, MS 39440 2010-12-23
1710135629 Jeffrey R. Moffett Nurse Practitioner 3115 Audubon Dr, Laurel, MS 39440 2008-09-04
1003096785 Family Health Center, Inc Obstetrics & Gynecology 103 S. 12th Avenue, Laurel, MS 39440 2007-11-09
1669672143 Laurel Urology Clinic Pa Urology 304 S 10th Ave, Laurel, MS 39440 2007-07-23
1093912370 Tanweer Hussain Majid Surgery 1007 Jefferson Street, Laurel, MS 39440 2007-06-29
1780889923 Hattiesburg Eye Clinic, Pa Ophthalmology 1431 North 10th St, Suite 1, Laurel, MS 39440 2007-06-18
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Taxonomy Information

Taxonomy Code 363LW0102X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Women's Health

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1467018226 Leena Daniel Nurse Practitioner 13 C Street, Suite D, Laurel, MD 20707 2019-05-16
1619916103 Sonya L Everett Nurse Practitioner 1008 N 15th Ave, Laurel, MS 39440-2656 2006-06-06
1447299508 Stephanie Crosby Nurse Practitioner 307 S. 13th Ave, Laurel, MS 39440-4342 2006-06-05
1245648104 Casey Herrington Nurse Practitioner 117 S 11th Ave, Laurel, MS 39440-4312 2014-07-23
1356380414 Heather Morris Nurse Practitioner 203 S 12th Ave, Laurel, MS 39440-4324 2006-06-05
1043265945 Pamela Morris Fleckenstein Nurse Practitioner 30668 Sussex Hwy, Laurel, DE 19956-4421 2006-05-23

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1972120665 Chelsea Lynne Mcgee Walley Nurse Practitioner 1880 Bakers Trl, Nesbit, MS 38651-6042 2020-06-29
1225675952 Victoria Delores Brown Nurse Practitioner 5155 Keele St Apt 22d, Jackson, MS 39206-4331 2019-12-02
1497280770 Jessica Wilder Nurse Practitioner 128 Cattail Ln, Ocean Springs, MS 39564-3863 2017-04-25
1609321702 Ashley Floyd Nurse Practitioner 1203 Avenue B Ste 300, Ellisville, MS 39437-2080 2016-08-18
1033571054 Debra Gail Gill Nurse Practitioner 4892 Briarton Dr, Southaven, MS 38672-9571 2016-03-29
1346652377 Rachel Nichole Ford Nurse Practitioner 5963 I 55 N, Jackson, MS 39213-9722 2014-05-26
1831485895 Anita Sharyl Clinton Donegan Nurse Practitioner 1012 Big Lane Dr, Brookhaven, MS 39601-2331 2011-06-28
1285861039 Katherine Young Nurse Practitioner 1212 Northpark Ln Ne, Brookhaven, MS 39601 2009-06-19
1295936839 Susan Turiano Crump Nurse Practitioner 111 Depot Dr # A, Madison, MS 39110-9395 2007-05-30
1760601967 Kimberly Lynne Schlagel Nurse Practitioner 1200 N State St Ste 430, Jackson, MS 39202-2027 2007-04-25
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Competitor

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City LAUREL
Zip Code 39440

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Dataset Information

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.

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