Provider Demographics
NPI:1093057465
Name:ROBERSON, CARA RUST (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CARA
Middle Name:RUST
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-2231
Mailing Address - Country:US
Mailing Address - Phone:731-989-0001
Mailing Address - Fax:731-989-5151
Practice Address - Street 1:1314 US HIGHWAY 45 N STE A
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-4003
Practice Address - Country:US
Practice Address - Phone:731-989-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ000621Medicaid