MEDICARE: AMBER ROBERTSON FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	F09241238	TX
2	363LF0000X	Family Nurse Practitioner	1192084	TX

General Provider Information

NPI Number	:	1396563086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER ROBERTSON FNP-C

Provider Business Mailing Address
First Line	:	13836 KOALSTAD RD
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77302-3504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 PINE MARKET AVE BLDG 2
Second Line	:
City	:	MONTGOMERY
State	:	TX
Zip	:	77316-5022
Country	:	US
Telephone Number	:	936-588-3514
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2024
Last Update Date	:	03/11/2025

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