Provider Demographics
NPI:1710227418
Name:ROARK, SARA KAY (NP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:KAY
Last Name:ROARK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:KAY
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6363 STATE HWY 161 STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2239
Mailing Address - Country:US
Mailing Address - Phone:469-200-3272
Mailing Address - Fax:
Practice Address - Street 1:6363 STATE HWY 161 STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2239
Practice Address - Country:US
Practice Address - Phone:817-732-2878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP123357363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX324359401Medicaid
TX324359401Medicaid