Healthcare Provider Details

I. General information

NPI: 1609528009
Provider Name (Legal Business Name): MICHELLE MARIE ROARK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 BREVARD RD
ASHEVILLE NC
28806-2945
US

IV. Provider business mailing address

101 SUNNY MEADOWS BLVD
ARDEN NC
28704-8824
US

V. Phone/Fax

Practice location:
  • Phone: 828-253-4437
  • Fax:
Mailing address:
  • Phone: 828-280-1454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5015632
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: