Healthcare Provider Details

I. General information

NPI: 1427891571
Provider Name (Legal Business Name): JESSICA J ROBERTS AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6712 RESTORACY DR
WHITESTOWN IN
46075-0089
US

IV. Provider business mailing address

21500 GISBORNE DR
NOBLESVILLE IN
46062-9344
US

V. Phone/Fax

Practice location:
  • Phone: 253-922-4027
  • Fax: 844-222-0800
Mailing address:
  • Phone: 317-603-0590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG05240006
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: