Healthcare Provider Details

I. General information

NPI: 1821292038
Provider Name (Legal Business Name): DIANA LYNN ROARK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA LYNN HARVEY FNP

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 DESALES AVENUE
CHATTANOOGA TN
37404
US

IV. Provider business mailing address

1949 GUNBARREL ROAD SUITE 230
CHATTANOOGA TN
37421
US

V. Phone/Fax

Practice location:
  • Phone: 423-495-7404
  • Fax: 423-485-2625
Mailing address:
  • Phone: 423-495-4345
  • Fax: 423-495-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000012256
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12256
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: