Shelly Gunnell Roark, NURSE PRACTITIONER

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

902947 Issued in MS

Practice address

5003 Hardy St Ste 350
Hattiesburg, MS 39402-1323

Phone

(601) 268-9393

Fax

(601) 268-9559

NPI assigned

Feb 20, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Women'S Health, PLLCGroup PAC ID 2567497985, 40 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shelly.roark.1@28954.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southern Women'S Health, PLLC

  • Obstetrics Physician
  • Jackson, MS
  • NPI 1174744379

  MS

  Medicare reassignment Care Compare group NPD
• Family Health Center, Inc

  • Clinic/Center
  • Laurel, MS
  • NPI 1760488357

  MS

  Medicare reassignment NPD
• Family Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Ellisville, MS
  • NPI 1083255087
  NPD
• Oxford Clinic for Women, PLLC

  • Specialist
  • Oxford, MS
  • NPI 1578105540
  NPD
• Southern Women'S Health, PLLC

  • Obstetrics & Gynecology Physician
  • Ellisville, MS
  • NPI 1407235971
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1550620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740355200000",
    "number": "1083170559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6524 U S HIGHWAY 98",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394028569",
            "telephone_number": "601-268-9393",
            "fax_number": "601-268-9559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5003 HARDY ST STE 350",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021323",
            "telephone_number": "601-268-9393",
            "fax_number": "601-268-9559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROARK",
        "first_name": "SHELLY",
        "middle_name": "GUNNELL",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-20",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "MS",
            "license": "902947",
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "MS",
            "license": "902947",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108317055",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Kathryn Rigel, SLP
• Laurie Ellen Risher, LCSW
• River Physicians Group LLC
• Patricia Chevis Rivers, DNP, FNP, RNFA
• Kineshia Abram Roark, D.M.D.
• Brett D Robbins, MD
• Eugenia E, Robbins, LPC
• Robert J Robbins, MD
• Susan L Robbins, MD
• Elizabeth Ann S Roberson, M.D.

• Women's Health Nurse Practitioner in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Women's Health Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.