Provider Demographics
NPI:1104168459
Name:ROBERTS, JESSIELA VENIS (MD)
Entity type:Individual
Prefix:DR
First Name:JESSIELA
Middle Name:VENIS
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W BRINKLEY LOOP
Mailing Address - Street 2:APT. 2
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-5033
Mailing Address - Country:US
Mailing Address - Phone:914-325-2103
Mailing Address - Fax:
Practice Address - Street 1:612 S 12TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4702
Practice Address - Country:US
Practice Address - Phone:479-785-2431
Practice Address - Fax:479-785-0732
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-9138207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine