Provider Demographics
NPI:1154302628
Name:ROBERTS, AMY LEA (CFNP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:LEA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-0900
Mailing Address - Country:US
Mailing Address - Phone:276-964-9102
Mailing Address - Fax:276-963-2865
Practice Address - Street 1:6719 GOV. G. C. PEERY HWY.
Practice Address - Street 2:SUITE 3100
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641
Practice Address - Country:US
Practice Address - Phone:276-964-9012
Practice Address - Fax:276-963-2865
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010260621Medicaid
WV3810000576Medicaid
VA010260621Medicaid