MEDICARE: JENNIFER ROBERTS-CLAYTON ARNP- CNP

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	1077693	TX

General Provider Information

NPI Number	:	1689311870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ROBERTS-CLAYTON ARNP- CNP

Provider Business Mailing Address
First Line	:	11460 COUNTY ROAD 3111 N
Second Line	:
City	:	KILGORE
State	:	TX
Zip	:	75662-7788
Country	:	US
Telephone Number	:	903-497-2868
Fax Number	:

Provider Business Practice Location Address
First Line	:	244 WESTVIEW TER
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-1620
Country	:	US
Telephone Number	:	903-497-2868
Fax Number	:

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

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	10/18/2024

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