Provider Demographics
NPI:1316991615
Name:ROBERTS, PATRICIA (MSN, CPNP, FNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MSN, CPNP, FNP
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 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4750 W OAKEY BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1535
Practice Address - Country:US
Practice Address - Phone:702-724-8844
Practice Address - Fax:702-724-8754
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN23860207KA0200X
NVAPRN00455363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HB048ZMedicare PIN
HB048ZMedicare PIN