MEDICARE: ARIEL ROBERSON

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	1021737	TX

General Provider Information

NPI Number	:	1770339962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIEL ROBERSON

Provider Business Mailing Address
First Line	:	405 DERBY LN
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-6324
Country	:	US
Telephone Number	:	903-714-2354
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 S AUSTIN AVE UNIT 1220
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-5640
Country	:	US
Telephone Number	:	737-265-7794
Fax Number	:

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

Provider Enumeration Date	:	04/29/2024
Last Update Date	:	05/19/2026

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