Individual
MRS. STEPHANIE SHADDEN ROARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
325 N STATE OF FRANKLIN RD FL 1, JOHNSON CITY, TN 37604-6056
(423) 439-7272
(423) 439-7235
Mailing address
950 SHADDEN RD, GRAY, TN 37615-4240
(423) 791-1263
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
4588
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q24385A
—
TN
Enumeration date
03/28/2023
Last updated
01/25/2024
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