MEDICARE: ANNTEZ ROBERSON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1096595	TX

General Provider Information

NPI Number	:	1083316533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNTEZ ROBERSON NP

Provider Business Mailing Address
First Line	:	2384 HIGHWAY 287 N STE 218
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-9207
Country	:	US
Telephone Number	:	817-546-8000
Fax Number	:	817-672-5172

Provider Business Practice Location Address
First Line	:	2384 HIGHWAY 287 N STE 218
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-9207
Country	:	US
Telephone Number	:	817-546-8000
Fax Number	:	817-672-5172

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	03/20/2023

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Directions to “ ANNTEZ ROBERSON NP” Practice Location

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