Provider Demographics
NPI:1780565572
Name:ROARK, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:ROARK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 MORRISON ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-3126
Mailing Address - Country:US
Mailing Address - Phone:615-962-8627
Mailing Address - Fax:
Practice Address - Street 1:820 N THOMPSON LN STE 1M
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-4341
Practice Address - Country:US
Practice Address - Phone:615-962-8627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician