Provider Demographics
NPI:1407426893
Name:ROARK, MELISSA REESE (NP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:REESE
Last Name:ROARK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:951 WENDOVER HEIGHT DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3565
Mailing Address - Country:US
Mailing Address - Phone:704-487-4677
Mailing Address - Fax:704-487-4677
Practice Address - Street 1:951 WENDOVER HEIGHT DR
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3565
Practice Address - Country:US
Practice Address - Phone:704-487-4677
Practice Address - Fax:704-487-4677
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5014404363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner