Provider Demographics
NPI:1407352735
Name:ROBERTS, CAREY LEIGH (NP-C)
Entity type:Individual
Prefix:
First Name:CAREY
Middle Name:LEIGH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CAREY
Other - Middle Name:LEIGH
Other - Last Name:WELDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:901 CONNECTOR 206 N
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-7150
Mailing Address - Country:US
Mailing Address - Phone:912-389-6732
Mailing Address - Fax:
Practice Address - Street 1:901 CONNECTOR 206 N
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-7150
Practice Address - Country:US
Practice Address - Phone:912-389-6732
Practice Address - Fax:912-393-1015
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN225856363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNO INSURANCES