Provider Demographics
NPI:1134651276
Name:ROBERTS, MARKETTA (APN)
Entity Type:Individual
Prefix:
First Name:MARKETTA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LONOKE
Mailing Address - State:AR
Mailing Address - Zip Code:72086-2011
Mailing Address - Country:US
Mailing Address - Phone:501-676-6560
Mailing Address - Fax:
Practice Address - Street 1:1306 N CENTER ST
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086-2011
Practice Address - Country:US
Practice Address - Phone:501-676-6560
Practice Address - Fax:501-676-7166
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005111363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily