Individual
MRS. KITTY A. ROARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
855 PIERREMONT RD, SUITE 126, SHREVEPORT, LA 71106-2084
(318) 868-5851
(318) 798-3348
Mailing address
855 PIERREMONT RD, SUITE 126, SHREVEPORT, LA 71106-2084
(318) 868-5851
(318) 798-3348
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1137383
—
LA
Enumeration date
02/08/2007
Last updated
03/31/2017
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