Shelly Gunnell Roark
Nurse Practitioner - Women's Health Nurse Practitioner - Community Health
103 S 12th Ave
Laurel
, Mississippi 39440-4322
Shelly Gunnell Roark
Nurse Practitioner - Women's Health Nurse Practitioner - Community Health
103 S 12th Ave
Laurel
, Mississippi 39440-4322
(601) 422-0431
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About
Features
Specialties
- Nurse Practitioner - Community Health
- Nurse Practitioner - Women's Health
Languages spoken
- English
Location
First Address
- Shelly Gunnell Roark
- 117 S 11th Ave
- Laurel, MS
- Zip : 39440-4312
- Fax : (601) 422-0431
- Phone : (601) 425-3033
Second Address
- Shelly Gunnell Roark
- 103 S 12th Ave
- Laurel, MS
- Zip : 39440-4322
- Phone : (601) 399-1970
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Is Shelly Gunnell Roark a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 363LC1500X | Nurse Practitioner - Community Health | 902947 | MS |
| Y | 363LW0102X | Nurse Practitioner - Women's Health | 902947 | MS |
National Provider Identifier
| NPI | 1083170559 |
|---|---|
| Provider Name | Shelly Gunnell Roark |
| First Address | Laurel, MS 39440-4312 |
| Second Address | Laurel, MS 39440-4322 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 20/02/2019 |
| Last Update Date | 19/01/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| PENDING | (05) | MS |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.