Provider Demographics
NPI:1043735509
Name:ROBERTS, DEREK L (APRN-BC)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 E 22ND ST N STE 1600-B
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2321
Mailing Address - Country:US
Mailing Address - Phone:316-201-6424
Mailing Address - Fax:316-201-6428
Practice Address - Street 1:8100 E 22ND ST N STE 1600-B
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2321
Practice Address - Country:US
Practice Address - Phone:316-201-6424
Practice Address - Fax:316-201-6428
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77798-092363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health