Provider Demographics
NPI:1316135619
Name:ROBERTS, JODY BROOKS (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:BROOKS
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:866-398-7107
Mailing Address - Fax:615-465-2879
Practice Address - Street 1:2301 S GREGG ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-5531
Practice Address - Country:US
Practice Address - Phone:432-267-5531
Practice Address - Fax:432-267-2025
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX687351163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
277206YK74Medicare PIN