Doctor Name: | MRS. KRISTINA ANN ROARK |
NPI Number: | 1235438144 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP-C |
License Number: | 3006867 |
Business Practice Address: | 81 Ball Park Rd Harlan, KY - 408311701 |
Business Phone Number: | 6065737322 |
Business Fax Number: | |
Mailing Address: | 81 Ball Park Rd, HARLAN |
State: | KY |
Postal Code: | 408311701 |
Phone Number: | 6065737322 |
Fax Number: | |
NPI Enumeration Date: | 03/17/2011 |
NPI Last Update Date: | 08/26/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 3006867 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |