Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | A004736 | AR |
NPI | 1013365006 |
---|---|
Provider Name | Kendra Roberts |
First Address | Little Rock, AR 72204-4247 |
Second Address | Malvern, AR 72104-6793 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2016 |
Last Update Date | 31/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A004736 | A004736 (01) | AR |