=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588589782
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JODY RAY ROBERTS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2026
-----------------------------------------------------
Last Update Date | 08/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 PARK RD
-----------------------------------------------------
City | NOCONA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76255-3616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-366-3762
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 302 S CROCKETT ST
-----------------------------------------------------
City | HENRIETTA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76365-3313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-366-3762
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 146L00000X
-----------------------------------------------------
Taxonomy Name | Paramedic
-----------------------------------------------------
License Number | 768695
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------