Individual
TERRI J ROARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
911 W 5TH AVENUE, SPOKANE, WA 99204
(509) 455-7844
(509) 623-0415
Mailing address
PO BOX 8500 LOCKBOX 7642, PHILADELPHIA, PA 19178-7642
(813) 281-8115
(813) 281-8656
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA10003201
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00393503
RR MEDICARE
WA
01
—
PA10003201
LICENSE
WA
Enumeration date
03/10/2006
Last updated
07/21/2022
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