Healthcare Provider Details

I. General information

NPI: 1114219003
Provider Name (Legal Business Name): JEANNIE CHARMAINE ROBERTS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SILVER LEAF DR
ALEXANDER AR
72002-7826
US

IV. Provider business mailing address

1010 SILVER LEAF DR
ALEXANDER AR
72002-7826
US

V. Phone/Fax

Practice location:
  • Phone: 501-909-9027
  • Fax:
Mailing address:
  • Phone: 501-909-9027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRA49280
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: