Individual
KIMBERLY MICHELLE ROARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1921 STONECIPHER DR, ADA, OK 74820-3439
(580) 436-3980
Mailing address
1925 WARRIOR WAY, ADA, OK 74820
(580) 421-4570
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
28987
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2004399800A
—
OK
Enumeration date
06/16/2008
Last updated
08/20/2018
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