Healthcare Provider Details

I. General information

NPI: 1154722569
Provider Name (Legal Business Name): CHRISTINE HAYNES ROBERTS BSN, RN, MSN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE STREET
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 NORTH STATE STREET JMM ROOM 2525
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-6270
  • Fax: 601-815-1828
Mailing address:
  • Phone: 601-984-6270
  • Fax: 601-815-1828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberR885733
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: