Individual
SHANNON MARIE ROARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RDN, CLC
Contact information
Practice address
185 TREASURE LN, JOHNSON CITY, TN 37604-7816
(423) 202-6404
(423) 979-3261
Mailing address
185 TREASURE LN, JOHNSON CITY, TN 37604-7816
(423) 202-6404
(423) 979-3261
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
917714
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
TN
Enumeration date
07/12/2007
Last updated
03/24/2025
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