Roark, Shelly Gunnell

Roark, Shelly Gunnell is an individual health care provider with primary practice located at 103 S 12Th Ave , Laurel MS 39440-4322. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Community Health, Physician Assistants & Advanced Practice Nursing Providers / Women's Health. Physician Assistants & Advanced Practice Nursing Providers / Women's Health is her primary health care specialty. Roark, Shelly Gunnell can be contacted via phone (601) 399-1970.

Contact Information

Primary practice address
103 S 12Th Ave Laurel MS 39440-4322
Phone: (601) 399-1970
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Community Health 363LC1500X 902947 Mississippi
Physician Assistants & Advanced Practice Nursing Providers / Women's Health 363LW0102X 902947 Mississippi

Profile Details

NPI number 1083170559
LBN Legal business name Roark, Shelly Gunnell
Credentials NURSE PRACTITIONER
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 20th, 2019
Last updated Jan 19th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083170559 NPPES
Mississippi MEDICAID PENDING

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