MEDICARE: LILLY IDA ROBERTS APN

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	A01186 ANP	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P000014273	OTHER	AR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	54041B477	OTHER	AR	BLUECROSS OF ARKANSAS

General Provider Information

NPI Number	:	1922003169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLY IDA ROBERTS APN

Provider Business Mailing Address
First Line	:	PO BOX 1060
Second Line	:
City	:	MARSHALL
State	:	AR
Zip	:	72650-1060
Country	:	US
Telephone Number	:	870-448-5733
Fax Number	:	870-448-5736

Provider Business Practice Location Address
First Line	:	322 DOGWOOD HOLLOW RD
Second Line	:
City	:	MOUNTAIN VIEW
State	:	AR
Zip	:	72560-8626
Country	:	US
Telephone Number	:	870-269-2995
Fax Number	:	870-269-2991

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	03/11/2020

Similar Medicare Providers

1982149662 — BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Practice Location Address:

322 DOGWOOD HOLLOW RD
MOUNTAIN VIEW, AR
72560-8626

Practice Phone: 999-999-9999
Practice Fax: 999-999-9999

1073271714 — DON MIN CHOI
Practice Location Address:

3305 SPRING MOUNTAIN RD STE 62
LAS VEGAS, NV
89102-8626

Practice Phone: 702-485-4838
Practice Fax:

1407503147 — TRANQUILITY HOSPICE CORP
Practice Location Address:

3305 SPRING MOUNTAIN RD STE 72
LAS VEGAS, NV
89102-8626

Practice Phone: 908-514-1956
Practice Fax:

1932815503 — BMB HEALTHCARE PARTNERS LLC
Practice Location Address:

3305 SPRING MOUNTAIN RD STE 65
LAS VEGAS, NV
89102-8626

Practice Phone: 626-267-0245
Practice Fax:

1568278844 — SILVER CREEK HOSPICE LLC
Practice Location Address:

3305 SPRING MOUNTAIN RD STE 72
LAS VEGAS, NV
89102-8626

Practice Phone: 323-423-9950
Practice Fax:

1467459370 — RONALD W SIMPSON MD
Practice Location Address:

19797 HWY 6
MOUNTAIN VIEW, AR
72560-1096

Practice Phone: 870-269-4144
Practice Fax: 870-269-5723

Directions to “ LILLY IDA ROBERTS APN” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.