MEDICARE: SCOTT LEE ROBERTS ARNP

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	363L00000X	Nurse Practitioner	AP60764788	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G9093275	OTHER	WA	PTAN

General Provider Information

NPI Number	:	1508394180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT LEE ROBERTS ARNP

Provider Business Mailing Address
First Line	:	1776 FOWLER ST
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99352-4833
Country	:	US
Telephone Number	:	509-735-9355
Fax Number	:	509-222-1151

Provider Business Practice Location Address
First Line	:	1776 FOWLER ST
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99352-4833
Country	:	US
Telephone Number	:	509-735-9355
Fax Number	:	509-222-1151

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

Provider Enumeration Date	:	05/26/2017
Last Update Date	:	01/28/2025

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