1003625195 NPI number — REGINA LYNN ROBERTS RN, CHS, CNHP, D. PS

NPI Number: 1003625195
Health Care Provider/Practitioner: REGINA LYNN ROBERTS RN, CHS, CNHP, D. PS

NPI Number : 1003625195 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003625195",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ROBERTS",
    "FirstName": "REGINA",
    "MiddleName": "LYNN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "RN, CHS, CNHP, D. PS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "226 CLAY DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "POUNDING MILL",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "24637-4320",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "276-345-6548",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "226 CLAY DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "POUNDING MILL",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "24637-4320",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "276-345-6548",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/02/2025",
    "LastUpdateDate": "01/02/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YP1600X",
          "TaxonomyName": "Pastoral Counselor",
          "LicenseNumber": "0001137015",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "0001137015",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "163WC0200X",
          "TaxonomyName": "Critical Care Medicine Registered Nurse",
          "LicenseNumber": "0001137015",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WE0003X",
          "TaxonomyName": "Emergency Registered Nurse",
          "LicenseNumber": "0001137015",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WG0000X",
          "TaxonomyName": "General Practice Registered Nurse",
          "LicenseNumber": "0001137015",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WH0200X",
          "TaxonomyName": "Home Health Registered Nurse",
          "LicenseNumber": "0001137015",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WI0500X",
          "TaxonomyName": "Infusion Therapy Registered Nurse",
          "LicenseNumber": "0001137015",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WN1003X",
          "TaxonomyName": "Nutrition Support Registered Nurse",
          "LicenseNumber": "0001137015",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WP0000X",
          "TaxonomyName": "Pain Management Registered Nurse",
          "LicenseNumber": "0001137015",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Registered Nurse",
          "LicenseNumber": "0001137015",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WR0400X",
          "TaxonomyName": "Rehabilitation Registered Nurse",
          "LicenseNumber": "0001137015",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WW0000X",
          "TaxonomyName": "Wound Care Registered Nurse",
          "LicenseNumber": "0001137015",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WX0200X",
          "TaxonomyName": "Oncology Registered Nurse",
          "LicenseNumber": "0001137015",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1744R1102X",
          "TaxonomyName": "Research Study Specialist",
          "LicenseNumber": "0001137015",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}