Individual
SHELLY GUNNELL ROARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
5003 HARDY ST STE 350, HATTIESBURG, MS 39402-1323
(601) 268-9393
(601) 268-9559
Mailing address
6524 U S HIGHWAY 98, HATTIESBURG, MS 39402-8569
(601) 268-9393
(601) 268-9559
Taxonomy
Speciality
Code
Description
License number
State
363LC1500X
Community Health Nurse Practitioner
902947
MS
363LW0102X
Women's Health Nurse Practitioner
Primary
902947
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108317055
—
MS
05
—
PENDING
—
MS
Enumeration date
02/20/2019
Last updated
02/24/2025
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