Provider Demographics
NPI:1164177515
Name:ROBERTS, GINGER A (NP)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:A
Last Name:ROBERTS
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 1:164 COUNTRY CLUB CIR STE B
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-7502
Mailing Address - Country:US
Mailing Address - Phone:318-639-9422
Mailing Address - Fax:318-639-9423
Practice Address - Street 1:164 COUNTRY CLUB CIR STE B
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-7502
Practice Address - Country:US
Practice Address - Phone:318-639-9422
Practice Address - Fax:318-639-9423
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA224016363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics