Provider Demographics
NPI:1336972694
Name:ROBERTS, CODY LANE (DNAP, CRNA, BSN)
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:LANE
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DNAP, CRNA, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 ROLLING HILL DR
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-7804
Mailing Address - Country:US
Mailing Address - Phone:205-260-9594
Mailing Address - Fax:
Practice Address - Street 1:3 MOBILE INFIRMARY CIR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3520
Practice Address - Country:US
Practice Address - Phone:251-435-2270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL151715367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered