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Individual

KEVIN A. ROARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
2430 EMERALD PL, SUITE 201, GREENVILLE, NC 27834-5784
(252) 752-2140
(252) 752-3949
Mailing address
2430 EMERALD PL, SUITE 201, GREENVILLE, NC 27834-5784
(252) 752-2140
(252) 752-3949

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
215024
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
082168
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8053549
NC
01
P00742958
RAILROAD MEDICARE
NC
Enumeration date
05/19/2009
Last updated
05/24/2010
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