Provider Demographics
NPI:1821235649
Name:O'ROARK, ASHLEY LAUREN (MS RD LD)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LAUREN
Last Name:O'ROARK
Suffix:
Gender:F
Credentials:MS RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 RODEO DR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-6640
Mailing Address - Country:US
Mailing Address - Phone:501-467-2947
Mailing Address - Fax:
Practice Address - Street 1:2302 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6297
Practice Address - Country:US
Practice Address - Phone:501-450-9292
Practice Address - Fax:501-932-0872
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1091133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered