1467739672 NPI number — MRS. CHRISTY RENEE ROBERTS NURSE PRACTITIONER

Table of content: KARL JOSEPH ZACK (NPI 1598347866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467739672 NPI number — MRS. CHRISTY RENEE ROBERTS NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
CHRISTY
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467739672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 S MEDFORD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUFKIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75901-6260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-639-1141
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7460 WARREN PKWY
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-4169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-668-5404
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  698873 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: AP120872 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0016SH . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2035487-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01006556 . This is a "PALMETTO RR" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2870578-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: D07564 . This is a "PALMETTO RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 865N98 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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