MS. MARY JACQUELINE ROBERTS APRN FNP NPI 1609150598

NPI Information

NPI: 1609150598
Provider Name: MS. MARY JACQUELINE ROBERTS, APRN, FNP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
1465 N GARDNER ST
SCOTTSBURG, IN
ZIP 47170
Phone: (812) 752-0001
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MS. Mary Jacqueline Roberts, APRN, FNP is a family nurse practitioner in Scottsburg, IN with 13 years of experience. MS. Mary Jacqueline Roberts, APRN, FNP NPI is 1609150598. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1465 N GARDNER ST
SCOTTSBURG, IN
ZIP 47170-751
Phone: (812) 752-0001
Fax: (812) 752-0010

The NPI 1609150598 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/10/2011 and was last updated on 2/26/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	3007173	KENTUCKY	No
2	363LF0000X	Nurse Practitioner	Family	71004757A	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	201050260	MEDICAID	INDIANA
2	7100186690	MEDICAID	KENTUCKY
3	71004757A	OTHER	INDIANA	STATE LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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