Individual
SUSETTE R ROARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3900 KRESGE WAY, STE 46, LOUISVILLE, KY 40207-4660
(502) 899-3858
(502) 899-3878
Mailing address
5200 COMMERCE CROSSINGS DR FL 3, LOUISVILLE, KY 40229-2182
(502) 253-4900
(502) 489-5750
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71006841A
IN
363LA2100X
Acute Care Nurse Practitioner
Primary
71006841A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71006841B
CDS LICENSE
IN
Enumeration date
01/30/2017
Last updated
03/07/2023
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