Healthcare Provider Details

I. General information

NPI: 1578493144
Provider Name (Legal Business Name): NATHAN SCOTT ROARK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NW VESPER ST
BLUE SPRINGS MO
64015-3219
US

IV. Provider business mailing address

110 NW 2ND ST
BLUE SPRINGS MO
64014-2819
US

V. Phone/Fax

Practice location:
  • Phone: 816-599-8360
  • Fax:
Mailing address:
  • Phone: 816-599-8360
  • Fax: 816-599-8360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number22-244722
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: