Individual
MR. LEO ROURKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
9075 SANDIDGE CENTER CV, OLIVE BRANCH, MS 38654-3514
(662) 893-8484
(662) 893-1103
Mailing address
9075 SANDIDGE CENTER CV, OLIVE BRANCH, MS 38654-3514
(662) 893-8484
(662) 893-1103
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
901896
MS
363LF0000X
Family Nurse Practitioner
APN0000006732
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3903211
FEDERAL MEDICARE NUMBER
TN
Enumeration date
10/17/2005
Last updated
02/09/2017
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