Healthcare Provider Details

I. General information

NPI: 1760809800
Provider Name (Legal Business Name): JASMINE MOON ROBERTS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 06/22/2025
Certification Date: 06/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W ASH ST
GOLDSBORO NC
27530-1078
US

IV. Provider business mailing address

1401 W ASH ST
GOLDSBORO NC
27530-1078
US

V. Phone/Fax

Practice location:
  • Phone: 919-947-8236
  • Fax:
Mailing address:
  • Phone: 919-947-8236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number29374
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number2018-00038
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: