| Doctor Name: | LARRY B ROARK |
| NPI Number: | 1437281649 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP-C |
| License Number: | 3005024 |
| Business Practice Address: | 2317 Cumberland Ave Middlesboro, KY - 409652834 |
| Business Phone Number: | 6062423100 |
| Business Fax Number: | 6062423984 |
| Mailing Address: | 2317 Cumberland Ave, MIDDLESBORO |
| State: | KY |
| Postal Code: | 409652834 |
| Phone Number: | 6062423100 |
| Fax Number: | 6062423984 |
| NPI Enumeration Date: | 03/12/2007 |
| NPI Last Update Date: | 11/07/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 3005024 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |