Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 0024171639 | VA |
NPI | 1003224908 |
---|---|
Provider Name | Jessica Davis Roberts |
First Address | Henrico, VA 23229-6714 |
Second Address | Richmond, VA 23298-0489 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2014 |
Last Update Date | 24/07/2014 |