Healthcare Provider Details

I. General information

NPI: 1003269895
Provider Name (Legal Business Name): JASON ROBERTS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 KIRTS BLVD STE 200
TROY MI
48084-4140
US

IV. Provider business mailing address

PO BOX 40412
BELFAST ME
04915-1255
US

V. Phone/Fax

Practice location:
  • Phone: 248-824-6500
  • Fax:
Mailing address:
  • Phone: 248-824-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704219864
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704219864
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704219864
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: