Provider Demographics
NPI:1083316533
Name:ROBERSON, ANNTEZ (NP)
Entity Type:Individual
Prefix:
First Name:ANNTEZ
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2384 HIGHWAY 287 N STE 218
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-9207
Mailing Address - Country:US
Mailing Address - Phone:817-546-8000
Mailing Address - Fax:817-672-5172
Practice Address - Street 1:2384 HIGHWAY 287 N STE 218
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9207
Practice Address - Country:US
Practice Address - Phone:817-546-8000
Practice Address - Fax:817-672-5172
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096595363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health