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General NPI Number Information
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NPI Number | 1013365006
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Entity Type | Individual
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Provider Name | KENDRA ROBERTS NP
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Gender | Female
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 100 WALCO LN
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City | MALVERN
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State | AR
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Zip | 72104-6793
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Country | US
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Telephone | 501-467-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 10107 SUFFOLK DR
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City | LITTLE ROCK
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State | AR
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Zip | 72204-4247
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Country | US
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Telephone | 501-952-3962
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | A004736
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License Number State | AR
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