Provider Demographics
NPI:1821666272
Name:ROARK, KACHELLE (HAIRLOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:KACHELLE
Middle Name:
Last Name:ROARK
Suffix:
Gender:F
Credentials:HAIRLOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3853
Mailing Address - Country:US
Mailing Address - Phone:614-537-4083
Mailing Address - Fax:
Practice Address - Street 1:1818 KNOLLWOOD DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-3853
Practice Address - Country:US
Practice Address - Phone:614-537-4083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist