Provider Demographics
NPI:1235438144
Name:ROARK, KRISTINA ANN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:ANN
Last Name:ROARK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 HIGHWAY 394
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617-5349
Mailing Address - Country:US
Mailing Address - Phone:423-662-7002
Mailing Address - Fax:423-662-7003
Practice Address - Street 1:1913 HIGHWAY 394
Practice Address - Street 2:
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617-5349
Practice Address - Country:US
Practice Address - Phone:423-662-7002
Practice Address - Fax:423-662-7003
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006867363LF0000X
TN22679363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily