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General NPI Number Information
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NPI Number | 1932976263
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Entity Type | Individual
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Provider Name | ELLE ROBERTS
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Gender | Female
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Dates
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Enumeration Date | 12/06/2023
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 1204 MEDICAL PLAZA CT
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City | GRANBURY
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State | TX
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Zip | 76048-5653
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Country | US
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Telephone | 817-573-5688
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Fax | 817-415-0722
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Provider Business Mailing Address
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Address Line | 47 HILL ST
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City | LOGAN
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State | OH
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Zip | 43138-1509
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA18330
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 12324567890
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License Number State | WV
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