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).
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 |
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 |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MS | PENDING | 05 |
Street Address |
103 S 12TH AVE |
City | LAUREL |
State | MS |
Zip Code | 39440-4322 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1073051892 | Carol Richardson | Family Medicine | 103 S 12th Ave, Laurel, MS 39440-4322 | 2017-02-01 |
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 |
Find all providers in zip 39440 |
Taxonomy Code | 363LW0102X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Women's Health |
Definition to come... |
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 |
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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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.