Healthcare Provider Details

I. General information

NPI: 1215858337
Provider Name (Legal Business Name): PATRICE ROBERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1001 N TRYON ST
CHARLOTTE NC
28206-3252
US

IV. Provider business mailing address

1341 LASALLE ST
CHARLOTTE NC
28216-4736
US

V. Phone/Fax

Practice location:
  • Phone: 980-200-9582
  • Fax:
Mailing address:
  • Phone: 980-200-9582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number42385013
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: