Provider Demographics
NPI:1962768481
Name:ROBERTSON, JAMES RYAN (ACNP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RYAN
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E MARKET ST STE C1
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-3747
Mailing Address - Country:US
Mailing Address - Phone:276-638-1983
Mailing Address - Fax:
Practice Address - Street 1:1 E MARKET ST STE C1
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3747
Practice Address - Country:US
Practice Address - Phone:276-638-1983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170443363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care