Active NPI
Michelle L Roark, CNM
- Midwife
- Meridian, MS
National Provider Identifier
1164863262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Midwife
- License
- A810516
- Practice address
- 905C S Frontage Rd
Meridian, MS 39301-6113 - Phone
- (601) 486-4210
- Fax
- (601) 482-4219
- NPI assigned
- Jul 17, 2013
- Last updated
- Feb 18, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Midwife | 176B00000X | A810516 | MS | Primary |
Addresses
Primary practice location
905C S Frontage Rd
Meridian, MS 39301-6113
Mailing address
PO Box 5208
Meridian, MS 39302-5208
Phone (601) 486-4210
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08106745 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A810516 | MS | MD | Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392681600000",
"number": "1164863262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5208",
"city": "MERIDIAN",
"state": "MS",
"postal_code": "393025208",
"telephone_number": "601-486-4210",
"fax_number": "601-486-4219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "905C S FRONTAGE RD",
"city": "MERIDIAN",
"state": "MS",
"postal_code": "393016113",
"telephone_number": "601-486-4210",
"fax_number": "601-482-4219"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROARK",
"first_name": "MICHELLE",
"middle_name": "L",
"credential": "CNM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-07-17",
"last_updated": "2014-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "176B00000X",
"taxonomy_group": "",
"desc": "Midwife",
"state": "MS",
"license": "A810516",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "08106745",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Meridian, MS
- Riley Healthcare LLC (The Oaks Rehabilitation and Healthcare Center)
- Mattie Ann Riley, LPN
- Andrew Mitchell Rinek, MD
- Nancy H. Risher, FNP
- Ritzi RX Medical Wig Clinic
- John Roberge
- Robert Crockett Enterprise LLC (Magnolia DME)
- Robert J Berg, MD PA
- Colby Roberts, LCSW
- Denise D Roberts, R.D., L.D., C.D.E.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2014; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.