Provider Demographics
NPI:1083197958
Name:ROBERTS, KATELIN (AGNP-C)
Entity Type:Individual
Prefix:
First Name:KATELIN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:KATELIN
Other - Middle Name:
Other - Last Name:RIALS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:874 ED HALL DR
Mailing Address - Street 2:
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-1861
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:874 ED HALL DR
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142
Practice Address - Country:US
Practice Address - Phone:972-932-5279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138304363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP138304OtherTEXAS BOARD OF NURSING