Healthcare Provider Details

I. General information

NPI: 1285917922
Provider Name (Legal Business Name): LATONYA ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8940 FOURWINDS DR STE 210
WINDCREST TX
78239-1900
US

IV. Provider business mailing address

15069 INTERSTATE 35 N STE 212
SELMA TX
78154-3568
US

V. Phone/Fax

Practice location:
  • Phone: 210-393-8614
  • Fax: 210-941-0642
Mailing address:
  • Phone: 210-393-8614
  • Fax: 210-941-0642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018086586
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: