Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 20757 | TN |
NPI | 1023477601 |
---|---|
Provider Name | Nikki Faye Roberts |
First Address | Gray, TN 37615-6205 |
Second Address | Elizabethton, TN 37643-3224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2016 |
Last Update Date | 03/11/2016 |