Provider Demographics
NPI:1932946498
Name:ROBERTS, JARVIS DE'KOVAN (DNP-FNP BC)
Entity type:Individual
Prefix:DR
First Name:JARVIS
Middle Name:DE'KOVAN
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DNP-FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4084
Mailing Address - Country:US
Mailing Address - Phone:704-830-6021
Mailing Address - Fax:
Practice Address - Street 1:500 IVERSON WAY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5635
Practice Address - Country:US
Practice Address - Phone:803-917-7736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5020480363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily