Provider Demographics
NPI:1285959239
Name:ROARK, KRISTEN NICHOLE (RN)
Entity type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:NICHOLE
Last Name:ROARK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 FOXHILL DR
Mailing Address - Street 2:APT. 2B
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6021
Mailing Address - Country:US
Mailing Address - Phone:937-405-5619
Mailing Address - Fax:
Practice Address - Street 1:2380 FOXHILL DR
Practice Address - Street 2:APT. 2B
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-6021
Practice Address - Country:US
Practice Address - Phone:937-405-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.338712163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse