Stephanie Shadden Roark, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

4588 Issued in TN

Practice address

325 N State of Franklin Rd FL 1
Johnson City, TN 37604-6056

Phone

(423) 439-7272

Fax

(423) 439-7235

NPI assigned

Mar 28, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Medical Education Assistance Corporation

  • Internal Medicine Physician
  • Johnson City, TN
  • NPI 1235180480
  Medicare reassignment NPD

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

{
    "created_epoch": "1679961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1639873235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 SHADDEN RD",
            "city": "GRAY",
            "state": "TN",
            "postal_code": "376154240",
            "telephone_number": "423-791-1263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 N STATE OF FRANKLIN RD FL 1",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046056",
            "telephone_number": "423-439-7272",
            "fax_number": "423-439-7235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROARK",
        "first_name": "STEPHANIE",
        "middle_name": "SHADDEN",
        "name_prefix": "Mrs.",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-28",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TN",
            "license": "4588",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q24385A",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lydia Pipes Roane, LCSW
• Amanda R Roark, CRNA
• Ericka Roark
• Kaara Roark, FNP
• Shannon Marie Roark, MS, RDN, CLC
• Christopher Robbins
• Margaret Shippen Robbins, M.D.
• Melissa A Robbins, FNP
• Robert E Roth PSYD
• Amy Michelle Roberts, LCSW

• Registered Dietitian in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Registered Dietitian in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.