Provider Demographics
NPI:1114219003
Name:ROBERTS, JEANNIE CHARMAINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:CHARMAINE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 SILVER LEAF DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-7826
Mailing Address - Country:US
Mailing Address - Phone:501-909-9027
Mailing Address - Fax:
Practice Address - Street 1:1010 SILVER LEAF DR
Practice Address - Street 2:
Practice Address - City:ALEXANDER
Practice Address - State:AR
Practice Address - Zip Code:72002-7826
Practice Address - Country:US
Practice Address - Phone:501-909-9027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARRA49280163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics