Healthcare Provider Details

I. General information

NPI: 1851624928
Provider Name (Legal Business Name): EMILY ROBERTS AUST CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CHURCH ST.
BELZONI MS
39038
US

IV. Provider business mailing address

P.O. BOX 633
BELZONI MS
39038
US

V. Phone/Fax

Practice location:
  • Phone: 662-247-2105
  • Fax: 662-247-4849
Mailing address:
  • Phone: 662-247-2105
  • Fax: 662-248-4849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR867435
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: