Individual
ADDISON ROARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
12902 E 51ST ST STE 3, TULSA, OK 74134-6712
(918) 994-3482
Mailing address
4209 N REDBUD PL, BROKEN ARROW, OK 74012-0453
(918) 978-8367
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5471
OK
Other
Enumeration date
02/22/2025
Last updated
02/22/2025
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